1063414571 NPI number — JL WEBB DME LLC

Table of content: (NPI 1063414571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063414571 NPI number — JL WEBB DME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JL WEBB DME LLC
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:
PRIORITY 1 MEDICAL EQUIPMENT
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:
1063414571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 31 W BYPASS
Provider Second Line Business Mailing Address:
STE 401
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-746-5745
Provider Business Mailing Address Fax Number:
270-746-5747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 31 W BYPASS
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-746-5745
Provider Business Practice Location Address Fax Number:
270-746-5747
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
270-746-5745

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 226929 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 90003534 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4040075 . This is a "BC/BS OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000278195 . This is a "BC/BS OF KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 25234 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1160919 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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