MEDICARE: JPS PHYSICIAN 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	282N00000X	General Acute Care Hospital		TX

General Provider Information

NPI Number	:	1184619082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPS PHYSICIAN GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 911294
Second Line	:	PHYSICIAN SERVICES
City	:	DALLAS
State	:	TX
Zip	:	75391-1294
Country	:	US
Telephone Number	:	817-852-8440
Fax Number	:	817-852-8432

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:	PHYSICIAN SERVICES
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-852-8440
Fax Number	:	817-852-8432

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. PATTY ANGELL
Credential	:
Telephone Number	:	817-852-8440

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	02/29/2008

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