Healthcare Provider Details

I. General information

NPI: 1508980350
Provider Name (Legal Business Name): J C ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 SO MAIN ST SUITE 4
SALT LAKE CITY UT
84115
US

IV. Provider business mailing address

2330 SO MAIN ST SUITE 4
SALT LAKE CITY UT
84115
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-9444
  • Fax:
Mailing address:
  • Phone: 801-466-9444
  • 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: MR. IAN HEAD
Title or Position: OWNER
Credential:
Phone: 801-466-9444