Provider Demographics
NPI:1700331014
Name:JED, INC
Entity Type:Organization
Organization Name:JED, INC
Other - Org Name:CHATEAU WOODLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-884-3839
Mailing Address - Street 1:327 TALLOW DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9533
Mailing Address - Country:US
Mailing Address - Phone:832-884-3839
Mailing Address - Fax:281-296-0066
Practice Address - Street 1:327 TALLOW DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9533
Practice Address - Country:US
Practice Address - Phone:832-884-3839
Practice Address - Fax:281-296-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143560302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization