Provider Demographics
NPI:1730582990
Name:JEP HEALTHCARE PROVIDER, LLC
Entity type:Organization
Organization Name:JEP HEALTHCARE PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:847-287-9102
Mailing Address - Street 1:1330 KETTERING RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5364
Mailing Address - Country:US
Mailing Address - Phone:847-388-4711
Mailing Address - Fax:
Practice Address - Street 1:1330 KETTERING RD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-5364
Practice Address - Country:US
Practice Address - Phone:847-287-9102
Practice Address - Fax:847-388-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty