Provider Demographics
NPI:1275158198
Name:JENNMIKE INC.
Entity Type:Organization
Organization Name:JENNMIKE INC.
Other - Org Name:MOBILITY PLUS - EVANSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-550-1444
Mailing Address - Street 1:1975 SAINT LUCIA DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9668
Mailing Address - Country:US
Mailing Address - Phone:216-246-9256
Mailing Address - Fax:
Practice Address - Street 1:525 N GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2472
Practice Address - Country:US
Practice Address - Phone:812-550-1444
Practice Address - Fax:812-550-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN69001599AOtherINDIANA PROFESSIONAL LICENSING AGENCY