Provider Demographics
NPI:1417108093
Name:J.R. MEDICAL CENTER, CORP.
Entity Type:Organization
Organization Name:J.R. MEDICAL CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RIOS BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-490-5771
Mailing Address - Street 1:427 W DUSSEL DR
Mailing Address - Street 2:SUITE# 336
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4208
Mailing Address - Country:US
Mailing Address - Phone:419-490-5771
Mailing Address - Fax:
Practice Address - Street 1:5700 MONROE ST
Practice Address - Street 2:SUITE: #120-379
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2767
Practice Address - Country:US
Practice Address - Phone:419-490-5771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty