Provider Demographics
NPI:1306351481
Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:JUPITER MEDICAL CENTER PHYSICIANS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-263-3602
Mailing Address - Street 1:PO BOX 9218
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9218
Mailing Address - Country:US
Mailing Address - Phone:561-263-7010
Mailing Address - Fax:561-263-7260
Practice Address - Street 1:2628 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-0000
Practice Address - Country:US
Practice Address - Phone:561-263-7010
Practice Address - Fax:561-744-8215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUPITER MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC12755261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care