Provider Demographics
NPI:1689975583
Name:JACKSON HOSPITAL DME
Entity Type:Organization
Organization Name:JACKSON HOSPITAL DME
Other - Org Name:RAYMOND M BLEDAY, MD ORTHOPEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CEO
Authorized Official - Phone:850-526-2200
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-526-2200
Mailing Address - Fax:850-718-2894
Practice Address - Street 1:4295 3RD AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2120
Practice Address - Country:US
Practice Address - Phone:850-482-0017
Practice Address - Fax:850-482-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies