MEDICARE: JBH PRIME 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	305S00000X	Point of Service
2	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1508740507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBH PRIME LLC

Provider Business Mailing Address
First Line	:	3713 CITATION DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-4832
Country	:	US
Telephone Number	:	573-217-4908
Fax Number	:	855-857-8425

Provider Business Practice Location Address
First Line	:	3713 CITATION DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-4832
Country	:	US
Telephone Number	:	573-217-4908
Fax Number	:	855-857-8425

Authorized Official
Title or Position	:	OWNER/ DAILY OPERATIONS MANAGER
Name	:	JACQUELYNNE BROCKMAN
Credential	:	CPT
Telephone Number	:	314-397-9004

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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Directions to “JBH PRIME LLC ” Practice Location

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