Provider Demographics
NPI:1356917785
Name:JP MEDICAL LLC
Entity type:Organization
Organization Name:JP MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-657-0926
Mailing Address - Street 1:1001 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5746
Mailing Address - Country:US
Mailing Address - Phone:843-473-7246
Mailing Address - Fax:
Practice Address - Street 1:1001 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5746
Practice Address - Country:US
Practice Address - Phone:843-473-7246
Practice Address - Fax:843-279-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies