Provider Demographics
NPI:1538108295
Name:J. T. MEDICAL, INC.
Entity Type:Organization
Organization Name:J. T. MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/AO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-785-5531
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:MALLIE
Mailing Address - State:KY
Mailing Address - Zip Code:41836-0076
Mailing Address - Country:US
Mailing Address - Phone:606-785-5531
Mailing Address - Fax:606-785-0223
Practice Address - Street 1:820 SOUTH HWY 160
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-5531
Practice Address - Fax:606-785-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90050360Medicaid
KY0287620001Medicare ID - Type Unspecified