MEDICARE: JGM SPINE, PLLC

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	2086S0129X	Vascular Surgery Physician	3168	OK

General Provider Information

NPI Number	:	1750513230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JGM SPINE, PLLC

Provider Business Mailing Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-241-3539
Fax Number	:	405-241-0998

Provider Business Practice Location Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-241-3539
Fax Number	:	405-241-0998

Authorized Official
Title or Position	:	OWNER/ PHYSICIAN
Name	:	DR. JIM G MELTON
Credential	:	D.O.
Telephone Number	:	405-241-3539

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	11/18/2015

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