Provider Demographics
NPI:1427563329
Name:JMC MEDICAL, LLC
Entity Type:Organization
Organization Name:JMC MEDICAL, LLC
Other - Org Name:JMC MOBILITY OF TALLAHASSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-524-6157
Mailing Address - Street 1:10723 SYCAMORE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-1733
Mailing Address - Country:US
Mailing Address - Phone:850-524-6157
Mailing Address - Fax:
Practice Address - Street 1:1989 CAPITAL CIR NE STE 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4476
Practice Address - Country:US
Practice Address - Phone:850-524-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty