Provider Demographics
NPI:1508740507
Name:JBH PRIME LLC
Entity type:Organization
Organization Name:JBH PRIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DAILY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:314-397-9004
Mailing Address - Street 1:3713 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4832
Mailing Address - Country:US
Mailing Address - Phone:573-217-4908
Mailing Address - Fax:855-857-8425
Practice Address - Street 1:3713 CITATION DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-4832
Practice Address - Country:US
Practice Address - Phone:573-217-4908
Practice Address - Fax:855-857-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service