MEDICARE: JBG MEDICAL GROUP, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134395130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBG MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1283
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-1283
Country	:	US
Telephone Number	:	972-265-6634
Fax Number	:	972-265-6631

Provider Business Practice Location Address
First Line	:	5700 GRANITE PKWY
Second Line	:	SUITE 900
City	:	PLANO
State	:	TX
Zip	:	75024-6622
Country	:	US
Telephone Number	:	972-265-6634
Fax Number	:	972-265-6631

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN T WILLIAMS
Credential	:
Telephone Number	:	972-265-6656

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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