Healthcare Provider Details

I. General information

NPI: 1265495410
Provider Name (Legal Business Name): JABEZ HOME INFUSION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 HEMBY LN SUITE B
GREENVILLE NC
27834-3733
US

IV. Provider business mailing address

2495 HEMBY LN SUITE B
GREENVILLE NC
27834-3733
US

V. Phone/Fax

Practice location:
  • Phone: 252-758-9304
  • Fax: 252-758-6904
Mailing address:
  • Phone: 252-758-9304
  • Fax: 252-758-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number08132
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number08132
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number08132
License Number StateNC

VIII. Authorized Official

Name: JAMES THOMAS COWART
Title or Position: PHARMACY MANAGER/CO-OWNER
Credential: RPH
Phone: 252-758-9304