Provider Demographics
NPI:1174816599
Name:COEJAC MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:COEJAC MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-631-7204
Mailing Address - Street 1:4309 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-2000
Mailing Address - Country:US
Mailing Address - Phone:912-631-7204
Mailing Address - Fax:912-631-7204
Practice Address - Street 1:4309 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2000
Practice Address - Country:US
Practice Address - Phone:912-631-7204
Practice Address - Fax:912-631-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies