MEDICARE: JAYMED 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	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V1003	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1326026170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYMED INC.

Provider Business Mailing Address
First Line	:	5846 SOUTH FLAMINGO RD #163
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330
Country	:	US
Telephone Number	:	954-889-0001
Fax Number	:	954-889-0003

Provider Business Practice Location Address
First Line	:	5846 SOUTH FLAMINGO RD #163
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330
Country	:	US
Telephone Number	:	954-448-2350
Fax Number	:	954-889-0003

Authorized Official
Title or Position	:	CEO
Name	:	MR. CRAIG RUBIN
Credential	:
Telephone Number	:	954-448-2350

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	11/06/2015

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Directions to “JAYMED INC. ” Practice Location

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