Provider Demographics
NPI:1063885374
Name:JM PROFESSIONALS, IN
Entity type:Organization
Organization Name:JM PROFESSIONALS, IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-606-1498
Mailing Address - Street 1:PO BOX 166242
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72216-6242
Mailing Address - Country:US
Mailing Address - Phone:501-606-1498
Mailing Address - Fax:501-400-7993
Practice Address - Street 1:13718 TRETHORNE CIR
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-5052
Practice Address - Country:US
Practice Address - Phone:501-606-1498
Practice Address - Fax:501-400-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies