Provider Demographics
NPI:1851612725
Name:JENCO PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:JENCO PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-566-5795
Mailing Address - Street 1:1153 N MAIN ST
Mailing Address - Street 2:SUITE B-140
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2495
Mailing Address - Country:US
Mailing Address - Phone:435-750-6579
Mailing Address - Fax:801-566-5790
Practice Address - Street 1:1153 N MAIN ST
Practice Address - Street 2:SUITE B-140
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2495
Practice Address - Country:US
Practice Address - Phone:435-750-6579
Practice Address - Fax:801-566-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier