MEDICARE: MR. JIMMIE STUBBS

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	171M00000X	Case Manager/Care Coordinator		DC

General Provider Information

NPI Number	:	1285334219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMIE STUBBS

Provider Business Mailing Address
First Line	:	6605 HIL MAR DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-4145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6605 HIL MAR DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-4145
Country	:	US
Telephone Number	:	202-787-8678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	04/13/2023

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