Provider Demographics
NPI:1366855025
Name:JETHRO MEDICAL, LLC
Entity Type:Organization
Organization Name:JETHRO MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-494-4900
Mailing Address - Street 1:2142 N. FINE AVE.
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1513
Mailing Address - Country:US
Mailing Address - Phone:559-494-4900
Mailing Address - Fax:559-494-4900
Practice Address - Street 1:2142 N FINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1513
Practice Address - Country:US
Practice Address - Phone:559-307-3342
Practice Address - Fax:559-494-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies