Provider Demographics
NPI:1104047430
Name:JENCO MEDICAL, INC.
Entity type:Organization
Organization Name:JENCO MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-566-5795
Mailing Address - Street 1:7026 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1026
Mailing Address - Country:US
Mailing Address - Phone:801-566-5795
Mailing Address - Fax:801-566-5790
Practice Address - Street 1:1153 N MAIN ST
Practice Address - Street 2:SUITE B140
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2495
Practice Address - Country:US
Practice Address - Phone:435-750-6579
Practice Address - Fax:435-750-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT03192002Medicare NSC