Provider Demographics
NPI:1588610067
Name:JJP FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:JJP FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-358-2392
Mailing Address - Street 1:302 S HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5333
Mailing Address - Country:US
Mailing Address - Phone:361-358-2392
Mailing Address - Fax:361-358-7640
Practice Address - Street 1:302 S HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5333
Practice Address - Country:US
Practice Address - Phone:361-358-9912
Practice Address - Fax:361-358-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QR1300X
TX207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083HGOtherBCBS TEXAS ID NUMBER RHC
TX148458601Medicaid
TX0083HGOtherBCBS TEXAS ID NUMBER RHC
TX148458601Medicaid