MEDICARE: JC MEDICAL OFFICE 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	208D00000X	General Practice Physician		FL

General Provider Information

NPI Number	:	1548357783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JC MEDICAL OFFICE INC

Provider Business Mailing Address
First Line	:	3300 W 84TH ST
Second Line	:	BAY # 16
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:	305-456-9267
Fax Number	:	305-456-9394

Provider Business Practice Location Address
First Line	:	3300 W 84TH ST
Second Line	:	BAY # 16
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:	305-456-9267
Fax Number	:	305-456-9394

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESUS REALES
Credential	:	M.D.
Telephone Number	:	305-456-9267

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	04/13/2016

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