Provider Demographics
NPI:1851569339
Name:JVC FAMILY MEDICINE
Entity Type:Organization
Organization Name:JVC FAMILY MEDICINE
Other - Org Name:JASON DEMATTIA MD OR CANDICE DEMATTIA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:DEMATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-466-0197
Mailing Address - Street 1:17376 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1114
Mailing Address - Country:US
Mailing Address - Phone:713-466-0197
Mailing Address - Fax:866-328-6260
Practice Address - Street 1:17376 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-1114
Practice Address - Country:US
Practice Address - Phone:713-466-0197
Practice Address - Fax:866-328-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty