Provider Demographics
NPI:1144491804
Name:JIREH DME SUPPLIES, INC.
Entity type:Organization
Organization Name:JIREH DME SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-820-6476
Mailing Address - Street 1:7505 PINES RD
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3935
Mailing Address - Country:US
Mailing Address - Phone:318-820-6476
Mailing Address - Fax:877-676-8988
Practice Address - Street 1:7505 PINES RD
Practice Address - Street 2:SUITE 1240
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3935
Practice Address - Country:US
Practice Address - Phone:318-820-6476
Practice Address - Fax:877-676-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies