Provider Demographics
NPI:1043352073
Name:JCL & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:JCL & ASSOCIATES, INC.
Other - Org Name:DIABETES EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-941-4254
Mailing Address - Street 1:219 KATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9588
Mailing Address - Country:US
Mailing Address - Phone:601-982-9050
Mailing Address - Fax:601-982-9054
Practice Address - Street 1:219 KATHERINE DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9588
Practice Address - Country:US
Practice Address - Phone:601-982-9050
Practice Address - Fax:601-982-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4982420001Medicare NSC