Provider Demographics
NPI:1184619082
Name:JPS PHYSICIAN GROUP INC
Entity type:Organization
Organization Name:JPS PHYSICIAN GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-852-8440
Mailing Address - Street 1:PO BOX 911294
Mailing Address - Street 2:PHYSICIAN SERVICES
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1294
Mailing Address - Country:US
Mailing Address - Phone:817-852-8440
Mailing Address - Fax:817-852-8432
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:PHYSICIAN SERVICES
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-852-8440
Practice Address - Fax:817-852-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00638VMedicare PIN