Organization
JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK LLC
Active
Other names
JenCare Neighborhood Medical Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MARY CHEN (AUTHORIZED OFFICIAL)
(305) 831-4722
Entity
Organization
Contact information
Practice address
524 SOUTHPARK BLVD, COLONIAL HEIGHTS, VA 23834-3609
(305) 653-1770
Mailing address
1395 NW 167TH ST, MIAMI, FL 33169-5710
(305) 628-6117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
05/22/2012
Last updated
02/20/2025
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