Provider Demographics
NPI:1841722535
Name:JOSEPH L. LESCANO
Entity type:Organization
Organization Name:JOSEPH L. LESCANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESCANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-888-6402
Mailing Address - Street 1:P.O. BOX 505196
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-233-0240
Mailing Address - Fax:670-233-0241
Practice Address - Street 1:UNIT 101 MANGO CITY BLDG. MIDDLE ROAD, GARAPAN
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-233-0240
Practice Address - Fax:670-233-0241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH L. LESCANO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-31
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP458158OtherTHE JOINT COMMISSION
MP3R-055Medicaid