Provider Demographics
NPI:1730475807
Name:JAC MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:JAC MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-2033
Mailing Address - Street 1:8001 W 26TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8001 W 26TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2753
Practice Address - Country:US
Practice Address - Phone:305-827-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9144261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center