Provider Demographics
NPI:1659535607
Name:JSCO ENTERPRISES PLLC
Entity Type:Organization
Organization Name:JSCO ENTERPRISES PLLC
Other - Org Name:THE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCOUFOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-774-0147
Mailing Address - Street 1:555 W. RUTH ST.
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-7039
Mailing Address - Country:US
Mailing Address - Phone:918-774-0147
Mailing Address - Fax:918-774-0286
Practice Address - Street 1:555 W. RUTH ST.
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-7039
Practice Address - Country:US
Practice Address - Phone:918-774-0147
Practice Address - Fax:918-774-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5461Medicare PIN
OKOK700518Medicare PIN