Provider Demographics
NPI:1164695888
Name:JENSEN BEACH ANIMAL HOSPITAL , LLC
Entity Type:Organization
Organization Name:JENSEN BEACH ANIMAL HOSPITAL , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:772-334-5010
Mailing Address - Street 1:1553 NE ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5755
Mailing Address - Country:US
Mailing Address - Phone:772-334-5010
Mailing Address - Fax:772-334-7447
Practice Address - Street 1:1553 NE ARCH AVE
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5755
Practice Address - Country:US
Practice Address - Phone:772-334-5010
Practice Address - Fax:772-334-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVE3623284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital