Jackson Durable Medical Equipment LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5232270001 Issued in TX

Legal business name

JACKSON DURABLE MEDICAL EQUIPMENT LLC

Doing business as

Valley Medical Depot

Practice address

5510 S Jackson Rd
Edinburg, TX 78539-9902

Phone

(956) 682-6769

Fax

(956) 682-4447

NPI assigned

Aug 20, 2006

Last updated

Sep 30, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ahmed Monif Nazif

Title

Owner

Phone

(956) 682-6769

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• VALLEY MEDICAL DEPOT Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1669587515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 S JACKSON RD",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785399902",
            "telephone_number": "956-682-6769",
            "fax_number": "956-682-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 S JACKSON RD",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785399902",
            "telephone_number": "956-682-6769",
            "fax_number": "956-682-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DURABLE MEDICAL EQUIPMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "NAZIF",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "MONIF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-682-6769",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "5232270001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171204401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VALLEY MEDICAL DEPOT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cheriese Izo
• J Michael Adame DDS PA
• J Ricardo Sobrevilla MD PLLC
• J W Havener PLLC
• Jackson Creek Dental Center (University Dental Center)
• Courtney Jackson, SLP ASSISTANT
• Diana Beltran Jackson, M.S. CCC-SLP
• Ronald B Jackson, PT
• Bobby Jacob
• Ashley Jacobs, COTA

• Durable Medical Equipment & Medical Supplies in Edinburg, TX
• Providers in Edinburg, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.