Provider Demographics
NPI:1184056285
Name:JRCO, LLC
Entity type:Organization
Organization Name:JRCO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BEEZLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:662-356-0320
Mailing Address - Street 1:9692 WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-9223
Mailing Address - Country:US
Mailing Address - Phone:662-356-0320
Mailing Address - Fax:662-356-0322
Practice Address - Street 1:9692 WOLFE RD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MS
Practice Address - Zip Code:39740
Practice Address - Country:US
Practice Address - Phone:662-356-0320
Practice Address - Fax:662-356-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07757360Medicaid
MS512I110141OtherMEDICARE PTAN
MSF82085Medicare UPIN