Provider Demographics
NPI:1205155777
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:MR
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 1:7026 SOUTH COMMERCE PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1031
Mailing Address - Country:US
Mailing Address - Phone:801-566-5795
Mailing Address - Fax:801-566-5790
Practice Address - Street 1:7026 SOUTH COMMERCE PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1026
Practice Address - Country:US
Practice Address - Phone:801-566-5795
Practice Address - Fax:801-566-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6254110001Medicare NSC