Provider Demographics
NPI:1114485703
Name:JPS ANESTHESIA LLC
Entity Type:Organization
Organization Name:JPS ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-396-8109
Mailing Address - Street 1:5302 GATEWAY CTR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3930
Mailing Address - Country:US
Mailing Address - Phone:248-396-8109
Mailing Address - Fax:
Practice Address - Street 1:5302 GATEWAY CTR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3930
Practice Address - Country:US
Practice Address - Phone:248-396-8109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty