Provider Demographics
NPI:1962460428
Name:JSM ENTERPRISES, LLC
Entity type:Organization
Organization Name:JSM ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MODICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-567-5445
Mailing Address - Street 1:PO BOX 796002
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-6000
Mailing Address - Country:US
Mailing Address - Phone:314-567-4449
Mailing Address - Fax:314-567-0762
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:STE. 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-567-4449
Practice Address - Fax:314-567-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
189278OtherGROUP HEALTH PLAN
8351165OtherAETNA
MO193989OtherBCBS
0635411 OR 0668136OtherCIGNA
10439OtherESSENCE
A-33594OtherMULTIPLAN
237811OtherHEALTHLINK
113199OtherHEALTH PARTNERS
44935OtherHEALTHCARE USA
852262OtherFIRST HEALTH
10439OtherESSENCE