Provider Demographics
NPI:1134311616
Name:MADISON COUNTY MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:MADISON COUNTY MEDICAL EQUIPMENT INC
Other - Org Name:JACKSON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:3325 BARTLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6428
Mailing Address - Country:US
Mailing Address - Phone:407-206-0040
Mailing Address - Fax:407-206-0010
Practice Address - Street 1:1624 LAKE AVE STE 1
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588
Practice Address - Country:US
Practice Address - Phone:877-262-7005
Practice Address - Fax:712-662-7708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROCARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0208544Medicaid
IA1289130004Medicare NSC