Healthcare Provider Details

I. General information

NPI: 1104047430
Provider Name (Legal Business Name): JENCO MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 N MAIN ST SUITE B140
LOGAN UT
84341-2495
US

IV. Provider business mailing address

7026 COMMERCE PARK DR SUITE 2
MIDVALE UT
84047-1026
US

V. Phone/Fax

Practice location:
  • Phone: 435-750-6579
  • Fax: 435-750-6586
Mailing address:
  • Phone: 801-566-5795
  • Fax: 801-566-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ERIN COLLEEN CHILDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-566-5795