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NPI Code Detail

MEDICARE: MY JOURNEY JMT INC

MEDICARE: MY JOURNEY JMT 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
1261QD1600XDevelopmental Disabilities Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336757087
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY JOURNEY JMT INC
Provider Business Mailing Address
First Line : 7241 BLACKHAWK TRL
Second Line :
City : SPRING HILL
State : FL
Zip : 34606-2519
Country : US
Telephone Number : 352-515-8202
Fax Number :
Provider Business Practice Location Address
First Line : 7241 BLACKHAWK TRL
Second Line :
City : SPRING HILL
State : FL
Zip : 34606-2519
Country : US
Telephone Number : 352-515-8202
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. JOSE M TROCHE
Credential : PERSONAL SUPPORT REP
Telephone Number : 352-515-8202
Provider Enumeration Date : 07/20/2020
Last Update Date : 07/20/2020

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