1316337827 NPI number — JM FAMILY ENTERPRISES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316337827 NPI number — JM FAMILY ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JM FAMILY ENTERPRISES, INC
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:
ST LOUIS HEALTH & WELLNESS CENTER
Provider Other Organization Name Type Code:
5
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:
1316337827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 JIM MORAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33442-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-429-2418
Provider Business Mailing Address Fax Number:
954-429-2148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 RIDER TRL S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARTH CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63045-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-702-4036
Provider Business Practice Location Address Fax Number:
314-702-4156
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
GROUP VICE PRESIDENT
Authorized Official Telephone Number:
954-596-3976

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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