Provider Demographics
NPI:1639217862
Name:JENCO MEDICAL, INC.
Entity Type:Organization
Organization Name:JENCO MEDICAL, INC.
Other - Org Name:UTAH PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:C P O
Authorized Official - Phone:801-566-5795
Mailing Address - Street 1:7026 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1026
Mailing Address - Country:US
Mailing Address - Phone:801-566-5795
Mailing Address - Fax:801-566-5790
Practice Address - Street 1:7026 COMMERCE PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1026
Practice Address - Country:US
Practice Address - Phone:801-566-5795
Practice Address - Fax:801-566-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTE99607332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870299464008Medicaid
UT103002163101OtherSELECTHEALTH IHC
UT199033OtherALTIUS
UT0319120001Medicare NSC