Provider Demographics
NPI:1811073414
Name:JUPITER FAMILY MEDICINE PC
Entity type:Organization
Organization Name:JUPITER FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-301-2500
Mailing Address - Street 1:6290 JUPITER AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8884
Mailing Address - Country:US
Mailing Address - Phone:616-301-2500
Mailing Address - Fax:616-301-2501
Practice Address - Street 1:6290 JUPITER AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8884
Practice Address - Country:US
Practice Address - Phone:616-301-2500
Practice Address - Fax:616-301-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR063678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty