Provider Demographics
NPI:1649232190
Name:JOANNE FODEMSKI
Entity Type:Organization
Organization Name:JOANNE FODEMSKI
Other - Org Name:JARAN MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FODEMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-226-0424
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1286
Mailing Address - Country:US
Mailing Address - Phone:219-226-0424
Mailing Address - Fax:219-226-0426
Practice Address - Street 1:730 WIRTZ RD
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-226-0424
Practice Address - Fax:219-226-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200466780AMedicaid
IN000000220428OtherBLUE SHIELD
IA0582874Medicaid
IN3900580001Medicare ID - Type Unspecified