Provider Demographics
NPI:1639509359
Name:JSA CLINICAL GROUP, INC.
Entity Type:Organization
Organization Name:JSA CLINICAL GROUP, INC.
Other - Org Name:JSA CLINICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-732-4343
Mailing Address - Street 1:JSA CLINICAL GROUP
Mailing Address - Street 2:9000 CYPRESS GREEN DRIVE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-732-4343
Mailing Address - Fax:904-732-4344
Practice Address - Street 1:JSA CLINICAL GROUP
Practice Address - Street 2:9000 CYPRESS GREEN DRIVE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:904-732-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty