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NPI Code Detail

MEDICARE: MR. JARVIS JAMAAR BUCHANAN

MEDICARE: MR. JARVIS JAMAAR BUCHANAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1083373450
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JARVIS JAMAAR BUCHANAN
Provider Business Mailing Address
First Line : 2350 JENSON CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-4814
Country : US
Telephone Number : 817-707-6645
Fax Number :
Provider Business Practice Location Address
First Line : 2350 JENSON CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-4814
Country : US
Telephone Number : 817-707-6645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2021
Last Update Date : 12/16/2021

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