Provider Demographics
NPI:1750513230
Name:JGM SPINE, PLLC
Entity type:Organization
Organization Name:JGM SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-241-3539
Mailing Address - Street 1:3200 QUAIL SPRINGS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2612
Mailing Address - Country:US
Mailing Address - Phone:405-241-3539
Mailing Address - Fax:405-241-0998
Practice Address - Street 1:3200 QUAIL SPRINGS PKWY
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2612
Practice Address - Country:US
Practice Address - Phone:405-241-3539
Practice Address - Fax:405-241-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31682086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty