MEDICARE: JPS ANESTHESIA LLC

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
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1114485703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPS ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	5302 GATEWAY CTR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3930
Country	:	US
Telephone Number	:	248-396-8109
Fax Number	:

Provider Business Practice Location Address
First Line	:	5302 GATEWAY CTR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3930
Country	:	US
Telephone Number	:	248-396-8109
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	KYLE NIEPORTE
Credential	:
Telephone Number	:	248-396-8109

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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Directions to “JPS ANESTHESIA LLC ” Practice Location

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