Provider Demographics
NPI:1588281174
Name:JEDI FORCE INC
Entity type:Organization
Organization Name:JEDI FORCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-702-3683
Mailing Address - Street 1:2004 MONTANA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3414
Mailing Address - Country:US
Mailing Address - Phone:915-702-3683
Mailing Address - Fax:915-201-1318
Practice Address - Street 1:2004 MONTANA AVE STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3414
Practice Address - Country:US
Practice Address - Phone:915-702-3683
Practice Address - Fax:915-201-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies