Organization
JENCO MEDICAL, INC.
Active
Other names
Utah Prosthetics and Orthotics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW R BRACKEN C P O (OWNER PRESIDENT)
(801) 566-5795
Entity
Organization
Contact information
Practice address
7026 COMMERCE PARK DR, SUITE 2, MIDVALE, UT 84047-1026
(801) 566-5795
(801) 566-5790
Mailing address
7026 COMMERCE PARK DR, SUITE 2, MIDVALE, UT 84047-1026
(801) 566-5795
(801) 566-5790
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
E99607
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103002163101
SELECTHEALTH IHC
UT
01
—
199033
ALTIUS
UT
05
—
870299464008
—
UT
Enumeration date
02/01/2007
Last updated
08/22/2020
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