Provider Demographics
NPI:1225215288
Name:JENSEN MEDICAL
Entity Type:Organization
Organization Name:JENSEN MEDICAL
Other - Org Name:SOUND MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-881-0395
Mailing Address - Street 1:26129 CALVARY LN NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-7404
Mailing Address - Country:US
Mailing Address - Phone:360-881-0395
Mailing Address - Fax:360-297-7772
Practice Address - Street 1:26129 CALVARY LN NE
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-7404
Practice Address - Country:US
Practice Address - Phone:360-881-0395
Practice Address - Fax:360-297-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602049582332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437108834OtherNPI
WA9049206Medicaid
4094820001Medicare NSC