Provider Demographics
NPI:1669579595
Name:JAYSIX ENTERPRISES LLC
Entity type:Organization
Organization Name:JAYSIX ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-346-0533
Mailing Address - Street 1:7120 WYOMING BLVD NE
Mailing Address - Street 2:STE 7B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 WYOMING BLVD NE
Practice Address - Street 2:STE 7B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4887
Practice Address - Country:US
Practice Address - Phone:505-346-0533
Practice Address - Fax:505-346-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78726271Medicaid
3207861OtherOTHER ID NUMBER-COMMERCIAL NUMBER