Provider Demographics
NPI:1629251277
Name:JUPITER MEDICAL CENTER PHYSICIAN GROUP
Entity Type:Organization
Organization Name:JUPITER MEDICAL CENTER PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BILLING COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-2889
Mailing Address - Street 1:PO BOX 8850
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-8850
Mailing Address - Country:US
Mailing Address - Phone:561-748-2889
Mailing Address - Fax:561-748-1523
Practice Address - Street 1:399 TEQUESTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3087
Practice Address - Country:US
Practice Address - Phone:561-748-2889
Practice Address - Fax:561-748-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65271Medicare UPIN