Provider Demographics
NPI:1740626621
Name:JMP FAMILY PRACTICE INCORPORATED
Entity type:Organization
Organization Name:JMP FAMILY PRACTICE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-386-6374
Mailing Address - Street 1:PO BOX 290192
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0004
Mailing Address - Country:US
Mailing Address - Phone:803-787-3901
Mailing Address - Fax:803-787-3902
Practice Address - Street 1:3304 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4024
Practice Address - Country:US
Practice Address - Phone:803-787-3901
Practice Address - Fax:803-787-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center