1194141739 NPI number — JVM UNDERWEAR, INC

Table of content: (NPI 1194141739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194141739 NPI number — JVM UNDERWEAR, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JVM UNDERWEAR, 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:
Provider Other Organization Name Type Code:
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:
1194141739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1732 EAST 86TH PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-912-0852
Provider Business Mailing Address Fax Number:
855-606-3339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1732 EAST 86TH PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-912-0852
Provider Business Practice Location Address Fax Number:
855-606-3339
Provider Enumeration Date:
03/06/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
OWNER/PRESIDENT/INVENTOR
Authorized Official Telephone Number:
708-912-0852

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3010144496 . This is a "FDA REG" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".