Provider Demographics
NPI:1619769668
Name:JAY DAVIS ENTERPRISE LLC
Entity type:Organization
Organization Name:JAY DAVIS ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSE SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:682-391-7069
Mailing Address - Street 1:1109 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7116
Mailing Address - Country:US
Mailing Address - Phone:682-391-7069
Mailing Address - Fax:
Practice Address - Street 1:2600 W PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1114
Practice Address - Country:US
Practice Address - Phone:682-391-7069
Practice Address - Fax:682-391-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-17
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty