Provider Demographics
NPI:1073730602
Name:JETT MEDICAL CO LLC
Entity Type:Organization
Organization Name:JETT MEDICAL CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-481-9344
Mailing Address - Street 1:PO BOX 43566
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-0566
Mailing Address - Country:US
Mailing Address - Phone:205-678-8807
Mailing Address - Fax:
Practice Address - Street 1:1209 LAKE DR SE STE 111
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6488
Practice Address - Country:US
Practice Address - Phone:205-561-9572
Practice Address - Fax:205-481-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL585332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526611OtherBLUE CROSS
AL51526611OtherBLUE CROSS