Provider Demographics
NPI:1548666027
Name:JAX HOME MEDICAL
Entity type:Organization
Organization Name:JAX HOME MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:NORENNE
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-703-9534
Mailing Address - Street 1:120 MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:KY
Mailing Address - Zip Code:42051-8925
Mailing Address - Country:US
Mailing Address - Phone:270-703-9534
Mailing Address - Fax:
Practice Address - Street 1:120 MOUNTAIN RIDGE RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:KY
Practice Address - Zip Code:42051-8925
Practice Address - Country:US
Practice Address - Phone:270-703-9534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies