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NPI Code Detail

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK LLC

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK 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
1207R00000XInternal Medicine Physician
23336C0003XCommunity/Retail Pharmacy
3332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1134489214
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK LLC
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 305-628-6117
Fax Number :
Provider Business Practice Location Address
First Line : 524 SOUTHPARK BLVD
Second Line :
City : COLONIAL HEIGHTS
State : VA
Zip : 23834-3609
Country : US
Telephone Number : 305-653-1770
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MARY CHEN
Credential :
Telephone Number : 305-831-4722
Provider Enumeration Date : 05/22/2012
Last Update Date : 02/20/2025

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Directions to “JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK LLC ” Practice Location

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