Provider Demographics
NPI:1295042760
Name:JUPITER CANCER INSTITUTE, PA
Entity Type:Organization
Organization Name:JUPITER CANCER INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-2488
Mailing Address - Street 1:431 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3103
Mailing Address - Country:US
Mailing Address - Phone:561-748-2488
Mailing Address - Fax:561-748-2468
Practice Address - Street 1:431 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3103
Practice Address - Country:US
Practice Address - Phone:561-748-2488
Practice Address - Fax:561-748-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039739300Medicaid
FL039739300Medicaid