Provider Demographics
NPI:1770585929
Name:JARCO, INC.
Entity type:Organization
Organization Name:JARCO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-860-2691
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-0688
Mailing Address - Country:US
Mailing Address - Phone:573-897-4140
Mailing Address - Fax:573-897-4250
Practice Address - Street 1:304 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-9000
Practice Address - Country:US
Practice Address - Phone:573-897-4140
Practice Address - Fax:573-897-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO019091333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO624952800Medicaid
MO2621197OtherNCPDP
MO600587828Medicaid
MO6235070001Medicare NSC