Provider Demographics
NPI:1063751709
Name:JGA MEDICAL VENTURES, P.C.
Entity type:Organization
Organization Name:JGA MEDICAL VENTURES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ARMONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-828-3352
Mailing Address - Street 1:4798 WOODVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4523
Mailing Address - Country:US
Mailing Address - Phone:843-828-3352
Mailing Address - Fax:843-357-1471
Practice Address - Street 1:4798 WOODVIEW LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4523
Practice Address - Country:US
Practice Address - Phone:843-828-3352
Practice Address - Fax:843-357-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT26503Medicaid
SCG29299Medicare UPIN