Provider Demographics
NPI:1740423466
Name:JB INTERNAL MEDICINE
Entity type:Organization
Organization Name:JB INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-973-1564
Mailing Address - Street 1:201 KINGWOOD MEDICAL DR
Mailing Address - Street 2:SUITE A-300
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6012
Mailing Address - Country:US
Mailing Address - Phone:281-973-1564
Mailing Address - Fax:281-973-1569
Practice Address - Street 1:201 KINGWOOD MEDICAL DR
Practice Address - Street 2:SUITE A-300
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6012
Practice Address - Country:US
Practice Address - Phone:281-973-1564
Practice Address - Fax:281-973-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0043SGOtherBCBS
TX0A3662Medicare PIN