1356373153 NPI number — JACKSON HOME MEDICAL EQUIPMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356373153 NPI number — JACKSON HOME MEDICAL EQUIPMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HOME 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:
THE AUMACK COMPANY
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:
1356373153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 S BROWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49203-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-6910
Provider Business Mailing Address Fax Number:
517-782-8502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 S BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49203-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-6910
Provider Business Practice Location Address Fax Number:
517-782-8502
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MODRESKI
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
DIRECTOR/OFFICER
Authorized Official Telephone Number:
517-787-6910

Provider Taxonomy Codes

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

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

  • Identifier: 119550 . This is a "GREAT LAKES HEALTH PLAN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 303472887 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540C81221 . This is a "BCBS PROVIDER ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 119550 . This is a "GREAT LAKES HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1208 . This is a "NORTHWOOD PROVIDER ID NUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3034728 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52543 . This is a "NORTHWOOD NPN PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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