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General NPI Number Information
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NPI Number | 1396974531
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Entity Type | Organization
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Legal Business Name | JEMANI MEDICAL, LLC
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 140 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1698
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Country | US
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Telephone | 636-928-0078
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Fax | 636-928-0089
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Provider Business Mailing Address
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Address Line | 140 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1698
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Country | US
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Telephone | 636-928-0078
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Fax | 636-928-0089
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Authorized Official
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Title or Position | OWNER
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Name | MR. GERALD E MCCLELLAN
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Credential |
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Telephone | 563-650-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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