Provider Demographics
NPI:1346954815
Name:JR PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:JR PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-535-6511
Mailing Address - Street 1:5632 ANNAPOLIS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2213
Mailing Address - Country:US
Mailing Address - Phone:240-413-6485
Mailing Address - Fax:
Practice Address - Street 1:5632 ANNAPOLIS RD STE 8
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:240-413-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain