Provider Demographics
NPI:1588396105
Name:JPS INTERNATIONAL SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:JPS INTERNATIONAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:352-678-9472
Mailing Address - Street 1:2916 MAGNOLIA BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7522
Mailing Address - Country:US
Mailing Address - Phone:352-678-9472
Mailing Address - Fax:
Practice Address - Street 1:2916 MAGNOLIA BLOSSOM CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7522
Practice Address - Country:US
Practice Address - Phone:352-678-9472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty