Provider Demographics
NPI:1669619730
Name:JITA TECHNOLOGIES, LLC
Entity type:Organization
Organization Name:JITA TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTHO
Authorized Official - Middle Name:JEREMIAH
Authorized Official - Last Name:BLOCKSOM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:800-661-9048
Mailing Address - Street 1:4905 MISSION ST
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3415
Mailing Address - Country:US
Mailing Address - Phone:800-661-9048
Mailing Address - Fax:800-661-9048
Practice Address - Street 1:4905 MISSION ST
Practice Address - Street 2:APARTMENT B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3415
Practice Address - Country:US
Practice Address - Phone:800-661-9048
Practice Address - Fax:800-661-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies