1134110463 NPI number — JMF, INC.

Table of content: (NPI 1134110463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134110463 NPI number — JMF, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JMF, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE MEDICINE SHOPPE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134110463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 1ST AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58401-4745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-252-3002
Provider Business Mailing Address Fax Number:
701-252-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 1ST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-252-3002
Provider Business Practice Location Address Fax Number:
701-252-3149
Provider Enumeration Date:
11/04/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRES/OWNER
Authorized Official Telephone Number:
701-252-3002

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  126 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3502968 . This is a "NCPDP" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 1451979 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".