Organization
JESSCO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDITH LEE GALUARDI (ADMINISTRATOR)
(410) 641-9886
Entity
Organization
Contact information
Practice address
10308 OLD OCEAN CITY BLVD, BERLIN, MD 21811-1132
(410) 641-9886
(410) 641-1746
Mailing address
PO BOX 884, BERLIN, MD 21811-0884
(410) 641-9886
(410) 641-1746
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PENDING
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223Z
MEDICARE PTAN
MD
Enumeration date
10/18/2006
Last updated
10/28/2008
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