Provider Demographics
NPI:1568570893
Name:JENCO MEDICAL AND MOBILITY INC
Entity Type:Organization
Organization Name:JENCO MEDICAL AND MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-352-8440
Mailing Address - Street 1:2202 N TOTTEN CIR
Mailing Address - Street 2:STE A
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-6380
Mailing Address - Country:US
Mailing Address - Phone:812-352-8440
Mailing Address - Fax:812-352-8220
Practice Address - Street 1:2202 N TOTTEN CIR
Practice Address - Street 2:STE A
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-6380
Practice Address - Country:US
Practice Address - Phone:812-352-8440
Practice Address - Fax:812-352-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000189761OtherANTHEM
IN000000189761OtherANTHEM