Provider Demographics
NPI:1760695936
Name:JM WEST COAST INC
Entity Type:Organization
Organization Name:JM WEST COAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-514-3716
Mailing Address - Street 1:13505 SUMMIT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3326
Mailing Address - Country:US
Mailing Address - Phone:813-514-3716
Mailing Address - Fax:813-654-4278
Practice Address - Street 1:13505 SUMMIT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3326
Practice Address - Country:US
Practice Address - Phone:813-514-3716
Practice Address - Fax:813-654-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty