MEDICARE: THE JAMES LJ CENTER 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	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1124775408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE JAMES LJ CENTER LLC

Provider Business Mailing Address
First Line	:	5320 E MAIN ST STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2573
Country	:	US
Telephone Number	:	614-515-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 E MAIN ST STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2573
Country	:	US
Telephone Number	:	614-515-7570
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY JOHNSON
Credential	:
Telephone Number	:	614-515-7570

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	05/18/2023

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