Provider Demographics
NPI:1265676753
Name:TINA B. JASPAN
Entity Type:Organization
Organization Name:TINA B. JASPAN
Other - Org Name:JASPAN MEDICAL SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JASPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-400-4210
Mailing Address - Street 1:1936 N HIGHLAND AVE
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4537
Mailing Address - Country:US
Mailing Address - Phone:800-400-4210
Mailing Address - Fax:800-771-9243
Practice Address - Street 1:1936 N HIGHLAND AVE
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4537
Practice Address - Country:US
Practice Address - Phone:800-400-4210
Practice Address - Fax:800-771-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN991332B00000X
TN3066332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0877690001Medicare NSC