MEDICARE: JENCARE NEIGHBORHOOD MEDICAL EAST RICHMOND, 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	3336C0003X	Community/Retail Pharmacy
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891089454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENCARE NEIGHBORHOOD MEDICAL EAST RICHMOND, LLC

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-5742
Country	:	US
Telephone Number	:	305-628-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3806 MECHANICSVILLE TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1114
Country	:	US
Telephone Number	:	804-228-1143
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MARY CHEN
Credential	:
Telephone Number	:	305-831-4722

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	10/31/2024

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