Provider Demographics
NPI:1790784635
Name:JAKZ MEDICAL EQUIPMENT, SERVICE & SUPPLY
Entity Type:Organization
Organization Name:JAKZ MEDICAL EQUIPMENT, SERVICE & SUPPLY
Other - Org Name:JAKZ MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORKY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:PE, MBA
Authorized Official - Phone:317-815-0900
Mailing Address - Street 1:755 W CARMEL DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5877
Mailing Address - Country:US
Mailing Address - Phone:317-815-0900
Mailing Address - Fax:317-818-0853
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE 112
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-815-0900
Practice Address - Fax:317-818-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5546870001Medicare NSC