Provider Demographics
NPI:1760911051
Name:JEC PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:JEC PHYSICIAN SERVICES, LLC
Other - Org Name:COMPREHENSIVE SLEEP CARE OF SWFL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-444-8969
Mailing Address - Street 1:13670 METROPOLIS AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4346
Mailing Address - Country:US
Mailing Address - Phone:239-444-8969
Mailing Address - Fax:239-772-2927
Practice Address - Street 1:5272 SUMMERLIN COMMONS WAY STE 603
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2156
Practice Address - Country:US
Practice Address - Phone:239-444-8969
Practice Address - Fax:239-466-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70286207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31742OtherBCBS