Provider Demographics
NPI:1437656741
Name:JMC LLC
Entity Type:Organization
Organization Name:JMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCM
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-905-8797
Mailing Address - Street 1:800 HAZLETT AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6933
Mailing Address - Country:US
Mailing Address - Phone:304-905-8797
Mailing Address - Fax:
Practice Address - Street 1:800 HAZLETT AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6933
Practice Address - Country:US
Practice Address - Phone:304-905-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty