Provider Demographics
NPI:1851320022
Name:JAZA CORPORATION
Entity Type:Organization
Organization Name:JAZA CORPORATION
Other - Org Name:JAZA MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ODEMWINGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-340-7458
Mailing Address - Street 1:10721 PLANO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5348
Mailing Address - Country:US
Mailing Address - Phone:214-340-7458
Mailing Address - Fax:214-341-9034
Practice Address - Street 1:10721 PLANO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5348
Practice Address - Country:US
Practice Address - Phone:214-340-7458
Practice Address - Fax:214-341-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0043164332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4892950001Medicare ID - Type Unspecified