Organization Name: | JUBILEE MEDICAL FAMILY PRACTICE |
NPI Number: | 1235567785 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BOLAJI OWOLOJA (CEO) |
Mailing Address: | 722 Walnut St Reading |
State: | PA US |
Postal Code: | 196013520 |
Phone Number: | 4847697073 |
Fax Number: | 6104227062 |
NPI Enumeration Date: | 10/18/2013 |
NPI Last Update Date: | 10/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | SP011760 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |