Provider Demographics
NPI:1932539475
Name:JASPER MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:JASPER MEDICAL GROUP, LLC
Other - Org Name:HAMILTON PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-552-3575
Mailing Address - Street 1:1150 US HIGHWAY 41 NW
Mailing Address - Street 2:SUITE 11 & 12
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-5888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 US HIGHWAY 41 NW
Practice Address - Street 2:SUITE 11 & 12
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-5888
Practice Address - Country:US
Practice Address - Phone:239-552-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-20
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty