Provider Demographics
NPI:1215333596
Name:DR J S HOUSE CALLS LLC
Entity type:Organization
Organization Name:DR J S HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FAREMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-505-5877
Mailing Address - Street 1:3823 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6224
Mailing Address - Country:US
Mailing Address - Phone:313-505-5877
Mailing Address - Fax:
Practice Address - Street 1:160 LEEWARD CT
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-4111
Practice Address - Country:US
Practice Address - Phone:313-505-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG86682Medicare UPIN