Provider Demographics
NPI:1619090180
Name:JESSE MEDICAL EQUIPMENTS AND SUPPLIES
Entity Type:Organization
Organization Name:JESSE MEDICAL EQUIPMENTS AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-553-9320
Mailing Address - Street 1:9550 FOREST LN STE 214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6074
Mailing Address - Country:US
Mailing Address - Phone:214-553-9320
Mailing Address - Fax:241-221-7768
Practice Address - Street 1:9550 FOREST LN STE 214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6074
Practice Address - Country:US
Practice Address - Phone:214-553-9320
Practice Address - Fax:241-221-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0099197332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195048702Medicaid
TX195048702Medicaid