Provider Demographics
NPI:1730522921
Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Entity type:Organization
Organization Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE INTEGRITY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-263-2839
Mailing Address - Street 1:PO BOX 95000-8797
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:FL
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:561-263-7270
Mailing Address - Fax:561-263-7260
Practice Address - Street 1:5430 MILITARY TRAIL
Practice Address - Street 2:SUITE 64
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2873
Practice Address - Country:US
Practice Address - Phone:561-263-7010
Practice Address - Fax:561-776-3998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUPITER MEDICAL CENTER PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-08
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10499261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBD344OtherMEDICARE PTAN