Jenco Medical, Inc.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

E99607 Issued in UT

Legal business name

JENCO MEDICAL, INC.

Doing business as

Utah Prosthetics and Orthotics

Practice address

7026 Commerce Park Dr
Suite 2
Midvale, UT 84047-1026

Phone

(801) 566-5795

Fax

(801) 566-5790

NPI assigned

Feb 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Matthew R Bracken, C P O

Title

Owner President

Phone

(801) 566-5795

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Utah Prosthetics and Orthotics Doing business as

Tax ID family

Jenco Medical Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jenco Medical, Inc.

  • Customized Equipment (DME)
  • Logan, UT
  • NPI 1104047430
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639217862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7026 COMMERCE PARK DR",
            "address_2": "SUITE 2",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840471026",
            "telephone_number": "801-566-5795",
            "fax_number": "801-566-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7026 COMMERCE PARK DR",
            "address_2": "SUITE 2",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840471026",
            "telephone_number": "801-566-5795",
            "fax_number": "801-566-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENCO MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRACKEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "801-566-5795",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C P O"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "UT",
            "license": "E99607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870299464008",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTHEALTH IHC",
            "identifier": "103002163101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "199033",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utah Prosthetics and Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Philip Nathanael Isenberg, M.D.
• Peggy Elene Jacobsen, RN
• Alexis James
• Jamstan P C
• Janus RX LLC
• Jenco Prosthetics & Orthotics, LLC
• McKenzi Jean Jenkins
• Jennifer Fairbourn LMFT, LLC
• Joseph Dean Jensen, MD
• Krystynna Jensen

• Customized Equipment (DME) in Midvale, UT
• Providers in Midvale, UT by specialty
• Customized Equipment (DME) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.