Healthcare Provider Details

I. General information

NPI: 1548176241
Provider Name (Legal Business Name): JACK E-SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 119TH TER E
PARRISH FL
34219-5459
US

IV. Provider business mailing address

5017 119TH TER E
PARRISH FL
34219-5459
US

V. Phone/Fax

Practice location:
  • Phone: 814-746-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JACK HINES
Title or Position: CEO
Credential:
Phone: 814-746-0333