Provider Demographics
NPI:1366652844
Name:JENCO MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:JENCO MEDICAL INCORPORATED
Other - Org Name:UTAH PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:435-383-9000
Mailing Address - Street 1:2202 N MAIN ST. #102
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721
Mailing Address - Country:US
Mailing Address - Phone:435-383-9000
Mailing Address - Fax:435-383-9003
Practice Address - Street 1:2202 N. MAIN ST #102
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-383-9000
Practice Address - Fax:435-383-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870299464008Medicaid
UT870299464008Medicaid