Provider Demographics
NPI:1538106034
Name:EB & J MEDICAL INC
Entity Type:Organization
Organization Name:EB & J MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-891-2723
Mailing Address - Street 1:5 HOSPITAL PARK
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6772
Mailing Address - Country:US
Mailing Address - Phone:229-891-2723
Mailing Address - Fax:229-891-2793
Practice Address - Street 1:5 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-891-2723
Practice Address - Fax:229-891-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5478780001Medicare NSC