Provider Demographics
NPI:1619114402
Name:JCP 3 LLC
Entity Type:Organization
Organization Name:JCP 3 LLC
Other - Org Name:TR DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-279-9055
Mailing Address - Street 1:1021 HILL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2743
Mailing Address - Country:US
Mailing Address - Phone:269-279-9055
Mailing Address - Fax:
Practice Address - Street 1:1021 HILL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2743
Practice Address - Country:US
Practice Address - Phone:269-279-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1823Medicare PIN