Provider Demographics
NPI:1699272617
Name:JMCK HOLDING CORP
Entity type:Organization
Organization Name:JMCK HOLDING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:815-353-9789
Mailing Address - Street 1:5219 RITA AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3801
Mailing Address - Country:US
Mailing Address - Phone:815-353-9789
Mailing Address - Fax:
Practice Address - Street 1:930 PYOTT RD STE 101&102
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8720
Practice Address - Country:US
Practice Address - Phone:815-219-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service