Provider Demographics
NPI:1033290499
Name:JESSCO LLC
Entity Type:Organization
Organization Name:JESSCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GALUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-641-9886
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-0884
Mailing Address - Country:US
Mailing Address - Phone:410-641-9886
Mailing Address - Fax:410-641-1746
Practice Address - Street 1:10308 OLD OCEAN CITY BLVD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1132
Practice Address - Country:US
Practice Address - Phone:410-641-9886
Practice Address - Fax:410-641-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD223ZOtherMEDICARE PTAN