Provider Demographics
NPI:1508004029
Name:FJP LLC
Entity Type:Organization
Organization Name:FJP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YON
Authorized Official - Suffix:
Authorized Official - Credentials:ECT
Authorized Official - Phone:228-539-3356
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:228-539-3356
Mailing Address - Fax:228-539-3318
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-539-3356
Practice Address - Fax:228-539-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic