MEDICARE: JAUBERT PROSTHETICS, 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1780142836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAUBERT PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	1625 RYAN ST STE C
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5965
Country	:	US
Telephone Number	:	337-437-6134
Fax Number	:	337-437-6135

Provider Business Practice Location Address
First Line	:	1625 RYAN ST STE C
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5965
Country	:	US
Telephone Number	:	337-437-6134
Fax Number	:	337-437-6135

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSE BENITEZ, JR
Credential	:
Telephone Number	:	337-437-6134

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	04/10/2019

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