Provider Demographics
NPI:1750851085
Name:JACOBUS ORTHOPEDICS AND INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:JACOBUS ORTHOPEDICS AND INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-934-8787
Mailing Address - Street 1:118 CLAIR DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7771
Mailing Address - Country:US
Mailing Address - Phone:864-934-8787
Mailing Address - Fax:
Practice Address - Street 1:118 CLAIR DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7771
Practice Address - Country:US
Practice Address - Phone:864-934-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty