# JMJ3 HERITAGE, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548681950
- **Authorized official:** NAOMI CHELLI MD (ORGANIZER)
- **Authorized official phone:** (563) 508-5139

## Contact information

- **Practice address:** 3800 COMMERCE BLVD, DAVENPORT, IA 52807-3495
- **Practice address phone:** (563) 322-1888
- **Mailing address:** 3135 52ND AVENUE CT, BETTENDORF, IA 52722-6953
- **Mailing address phone:** (563) 508-5139
- **Mailing address fax:** (563) 359-3828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 35355 | IA | Yes |

## Other

- **Enumeration date:** 01/02/2014
- **Last updated:** 01/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 036111692 | ILLINOIS LICENSE | IL |
| 01 | — | 35355 | IOWA LICENSE | IA |