Provider Demographics
NPI:1689764425
Name:JENCYN INC
Entity Type:Organization
Organization Name:JENCYN INC
Other - Org Name:JENCYN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-476-5222
Mailing Address - Street 1:5521 SHADY CREEK CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1888
Mailing Address - Country:US
Mailing Address - Phone:402-476-5222
Mailing Address - Fax:402-476-5250
Practice Address - Street 1:5521 SHADY CREEK CT
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1888
Practice Address - Country:US
Practice Address - Phone:402-476-5222
Practice Address - Fax:402-476-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025577500Medicaid
NE5825240001Medicare NSC