Provider Demographics
NPI:1184971871
Name:JENCARE NEIGHBORHOOD MEDICAL METAIRIE, LLC
Entity type:Organization
Organization Name:JENCARE NEIGHBORHOOD MEDICAL METAIRIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-831-4722
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:3625 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4229
Practice Address - Country:US
Practice Address - Phone:504-452-1383
Practice Address - Fax:504-910-9371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMR US HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty