Provider Demographics
NPI:1720242837
Name:JED, INC
Entity type:Organization
Organization Name:JED, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-202-4958
Mailing Address - Street 1:327 TALLOW DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9533
Mailing Address - Country:US
Mailing Address - Phone:832-884-3839
Mailing Address - Fax:281-296-0066
Practice Address - Street 1:1507 HAMLIN VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2417
Practice Address - Country:US
Practice Address - Phone:832-249-7677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122032302R00000X
TX121886302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization