| Jupiter Wellness Center, Llc | |
|
312 S Old Dixie Hwy Ste 107 Jupiter FL 33458-7489 | |
| (561) 935-9622 | |
| (561) 935-9627 |
| Full Name | Jupiter Wellness Center, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 312 S Old Dixie Hwy Ste 107, Jupiter, Florida |
| Authorized Official Name and Position | Lori Bedoya (CEO) |
| Authorized Official Contact | 5619359622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jupiter Wellness Center, Llc 312 S Old Dixie Hwy Ste 107 Jupiter FL 33458-7489 Ph: (561) 935-9622 | Jupiter Wellness Center, Llc 312 S Old Dixie Hwy Ste 107 Jupiter FL 33458-7489 Ph: (561) 935-9622 |
| NPI Number | 1336615632 |
|---|---|
| Provider Enumeration Date | 10/15/2018 |
| Last Update Date | 06/10/2021 |
| Medicare PECOS PAC ID | 5092057521 |
|---|---|
| Medicare Enrollment ID | O20190501003355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336615632 | NPI | - | NPPES |
| 000000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Juan M Vidal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093796286 PECOS PAC ID: 1658336482 Enrollment ID: I20041122000355 |
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