Provider Demographics
NPI:1649384884
Name:JC MEDICAL ENTERPRISES, INC
Entity Type:Organization
Organization Name:JC MEDICAL ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-800-8386
Mailing Address - Street 1:10240 KNIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5027
Mailing Address - Country:US
Mailing Address - Phone:817-800-8386
Mailing Address - Fax:817-295-4992
Practice Address - Street 1:10240 KNIGHTS CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5027
Practice Address - Country:US
Practice Address - Phone:817-800-8386
Practice Address - Fax:817-295-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544119163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052HTOtherBCBS OF TX