Provider Demographics
NPI:1295721090
Name:JUPITER MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:JUPITER MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-263-2020
Mailing Address - Street 1:1210 SOUTH OLD DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7297
Mailing Address - Country:US
Mailing Address - Phone:561-263-2334
Mailing Address - Fax:
Practice Address - Street 1:1210 SOUTH OLD DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7297
Practice Address - Country:US
Practice Address - Phone:561-263-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG12000017699261QR0400X
FL4072282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012029400Medicaid
FL289OtherBLUE CROSS PROVIDER #
FL289OtherBLUE CROSS PROVIDER #