MEDICARE: JUPITER MEDICAL CENTER PAVILION 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	314000000X	Skilled Nursing Facility	SNF1263096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942296736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUPITER MEDICAL CENTER PAVILION INC

Provider Business Mailing Address
First Line	:	1230 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-744-4444
Fax Number	:	561-745-5730

Provider Business Practice Location Address
First Line	:	1230 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-744-4444
Fax Number	:	561-745-5730

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. BETSY HEARTFIELD
Credential	:
Telephone Number	:	561-744-4444

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/22/2020

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