Provider Demographics
NPI:1225560154
Name:JC MEDICAL CLINIC CORP
Entity Type:Organization
Organization Name:JC MEDICAL CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-717-4200
Mailing Address - Street 1:4010 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5721
Mailing Address - Country:US
Mailing Address - Phone:954-717-4200
Mailing Address - Fax:954-717-4459
Practice Address - Street 1:4010 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5721
Practice Address - Country:US
Practice Address - Phone:954-717-4200
Practice Address - Fax:954-717-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7721261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center