MEDICARE: JAX HEALTH 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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1326934605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAX HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 32614
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 W CAMPBELL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2612
Country	:	US
Telephone Number	:	602-834-6588
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAIME LECOMTE
Credential	:
Telephone Number	:	602-834-6588

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	06/14/2025

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Directions to “JAX HEALTH LLC ” Practice Location

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