Provider Demographics
NPI:1306293063
Name:JAI MEDICAL CENTER
Entity type:Organization
Organization Name:JAI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEUNARINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-433-2200
Mailing Address - Street 1:4340 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6725
Mailing Address - Country:US
Mailing Address - Phone:410-542-8130
Mailing Address - Fax:
Practice Address - Street 1:4340 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6725
Practice Address - Country:US
Practice Address - Phone:410-542-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR155112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty