1083971360 NPI number — JET MEDICAL CENTER LLC

Table of content: (NPI 1083971360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083971360 NPI number — JET MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JET MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083971360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 SW 19TH AVENUE RD UNIT 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-7758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
522-034-4083
Provider Business Mailing Address Fax Number:
844-602-4616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 SW 19 AV RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-629-9100
Provider Business Practice Location Address Fax Number:
352-629-9200
Provider Enumeration Date:
04/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHOKSI
Authorized Official First Name:
SAMER
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-203-4408

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  ME 96416 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X , with the licence number: ME96416 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)