Provider Demographics
NPI:1174268429
Name:JGBB LLC
Entity Type:Organization
Organization Name:JGBB LLC
Other - Org Name:SPECIALTY CARE INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:PATAWARAN
Authorized Official - Last Name:BUCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-478-5133
Mailing Address - Street 1:801 S RANCHO DR STE D1-B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3854
Mailing Address - Country:US
Mailing Address - Phone:702-587-5833
Mailing Address - Fax:
Practice Address - Street 1:511 E ROBINSON ST STE 2
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4070
Practice Address - Country:US
Practice Address - Phone:702-825-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JGBB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250004956Medicaid