Provider Demographics
NPI:1013314285
Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Entity Type:Organization
Organization Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Other - Org Name:JUPITER MEDICAL CENTER URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGALHAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-263-2234
Mailing Address - Street 1:PO BOX 9218
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9218
Mailing Address - Country:US
Mailing Address - Phone:561-263-7025
Mailing Address - Fax:561-263-7260
Practice Address - Street 1:1335 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4631
Practice Address - Country:US
Practice Address - Phone:561-263-7025
Practice Address - Fax:561-744-8215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-03
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL201578800261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBD344Medicare PIN