MEDICARE: JENEC GLOBAL LOGISTIC & INSURANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310500000X	Mental Illness Intermediate Care Facility	2012026743	MO
2	3140N1450X	Pediatric Skilled Nursing Facility	2012026743	MO
3	332B00000X	Durable Medical Equipment & Medical Supplies	2012026743	MO
4	3416L0300X	Land Ambulance	2012026743	MO

General Provider Information

NPI Number	:	1598205916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENEC GLOBAL LOGISTIC & INSURANCE LLC

Provider Business Mailing Address
First Line	:	3208 JANUARY AVE APT 1
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-1715
Country	:	US
Telephone Number	:	618-447-3448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 JANUARY AVE APT 1
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-1715
Country	:	US
Telephone Number	:	618-447-3448
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDEWOR BEN OSEVWE
Credential	:	RN
Telephone Number	:	618-447-3448

Provider Enumeration Date	:	03/04/2017
Last Update Date	:	03/04/2017

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