MEDICARE: JBCM-1

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	163W00000X	Registered Nurse	774906	TX

General Provider Information

NPI Number	:	1467732438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBCM-1

Provider Business Mailing Address
First Line	:	9402 MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1201
Country	:	US
Telephone Number	:	713-633-1626
Fax Number	:	713-635-6253

Provider Business Practice Location Address
First Line	:	9402 MESA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-1201
Country	:	US
Telephone Number	:	713-633-1626
Fax Number	:	713-635-6253

Authorized Official
Title or Position	:	SOLE MBR
Name	:	JACK T BARNETT
Credential	:	FNP
Telephone Number	:	713-633-1626

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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Directions to “JBCM-1 ” Practice Location

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