Provider Demographics
NPI:1669928321
Name:JERNIGAN'S MEDICAL SERVICES
Entity type:Organization
Organization Name:JERNIGAN'S MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LA TAUSHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-970-8159
Mailing Address - Street 1:5910 KENILWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033
Mailing Address - Country:US
Mailing Address - Phone:346-970-8159
Mailing Address - Fax:
Practice Address - Street 1:5910 KENILWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033
Practice Address - Country:US
Practice Address - Phone:346-970-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health