Provider Demographics
NPI:1871717249
Name:JM HEALTHCARE, PC
Entity type:Organization
Organization Name:JM HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-726-3311
Mailing Address - Street 1:402 EAST US HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402
Mailing Address - Country:US
Mailing Address - Phone:660-726-3311
Mailing Address - Fax:660-726-3206
Practice Address - Street 1:402 E US HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-8210
Practice Address - Country:US
Practice Address - Phone:660-726-3311
Practice Address - Fax:660-726-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO104860208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty