Provider Demographics
NPI:1467670034
Name:JEBOC INC
Entity Type:Organization
Organization Name:JEBOC INC
Other - Org Name:NEUROMUSCULAR ASSOCIATES OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCKILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:210-615-0270
Mailing Address - Street 1:4319 MEDICAL DR
Mailing Address - Street 2:STE 210A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3381
Mailing Address - Country:US
Mailing Address - Phone:210-615-0270
Mailing Address - Fax:210-615-0278
Practice Address - Street 1:4319 MEDICAL DR
Practice Address - Street 2:STE 210A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3381
Practice Address - Country:US
Practice Address - Phone:210-615-0270
Practice Address - Fax:210-615-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW23179104100000X
TX143615LVN164X00000X
TXF4450207RR0500X
TX1058048225100000X
TXPTA2030641225200000X
TXLMT002582225700000X
TXLMT007570225700000X
TXOT101127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20051757Medicare UPIN
TX456793Medicare ID - Type Unspecified