1891922985 NPI number — MADISON COUNTY MEDICAL EQUIPMENT INC

Table of content: (NPI 1891922985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891922985 NPI number — MADISON COUNTY MEDICAL EQUIPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON COUNTY MEDICAL EQUIPMENT 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:
JACKSON MEDICAL SUPPLY
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:
1891922985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/26/2018
NPI Reactivation Date:
08/13/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W GERMANTOWN PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 S GILBERT ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-569-8888
Provider Business Practice Location Address Fax Number:
866-769-8054
Provider Enumeration Date:
06/16/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO, PRESIDENT
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09162 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0207092 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".