MEDICARE: MID-WEST JCB INVESTMENTS 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	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1811704174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-WEST JCB INVESTMENTS LLC

Provider Business Mailing Address
First Line	:	1228 LINCOLN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 LINCOLN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1349
Country	:	US
Telephone Number	:	513-206-5094
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	CHEYENNE RILEY
Credential	:
Telephone Number	:	513-206-5094

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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