Provider Demographics
NPI:1285204958
Name:JAM WELLNESS CLINICS
Entity Type:Organization
Organization Name:JAM WELLNESS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS HEAD
Authorized Official - Prefix:MR
Authorized Official - First Name:JIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JADEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-372-3222
Mailing Address - Street 1:10007 BLUEWATER TER
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2731 W NORTHWEST HWY STE 104B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4788
Practice Address - Country:US
Practice Address - Phone:817-618-7667
Practice Address - Fax:817-618-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty