| Jlr Family Practice, Pc | |
|
3404 Newton St Jasper IN 47546-1020 | |
| (812) 634-7726 | |
| Not Available |
| Full Name | Jlr Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3404 Newton St, Jasper, Indiana |
| Authorized Official Name and Position | Jennifer Lynn Richardson (PRESIDENT) |
| Authorized Official Contact | 8126347726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jlr Family Practice, Pc 3404 Newton St Jasper IN 47546-1020 Ph: () - | Jlr Family Practice, Pc 3404 Newton St Jasper IN 47546-1020 Ph: (812) 634-7726 |
| NPI Number | 1710185319 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 04/19/2008 |
| Medicare PECOS PAC ID | 1355360041 |
|---|---|
| Medicare Enrollment ID | O20051111000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710185319 | NPI | - | NPPES |
| 200227510B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01047337A (Indiana) | Primary |
| Provider Name | Jennifer Lynn Richardson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740374826 PECOS PAC ID: 6305865981 Enrollment ID: I20051114000071 |
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