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General NPI Number Information
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NPI Number | 1366140469
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Entity Type | Organization
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Legal Business Name | JFM SAL LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 117 N 6TH ST
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City | QUINCY
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State | IL
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Zip | 62301-2903
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Country | US
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Telephone | 217-223-8791
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Fax | 217-223-8791
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Provider Business Mailing Address
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Address Line | 117 N 6TH ST
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City | QUINCY
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State | IL
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Zip | 62301-2903
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Country | US
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Telephone | 217-223-8791
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Fax | 217-223-8791
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Authorized Official
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Title or Position | OWNER
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Name | SARA ANN LEPPER
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Credential |
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Telephone | 217-242-6341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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