Organization
JOANNE FODEMSKI
Active
Other names
Jaran Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNE FODEMSKI (OWNER)
(219) 226-0424
Entity
Organization
Contact information
Practice address
730 WIRTZ RD, CROWN POINT, IN 46307
(219) 226-0424
(219) 226-0426
Mailing address
PO BOX 1286, CROWN POINT, IN 46308-1286
(219) 226-0424
(219) 226-0426
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220428
BLUE SHIELD
IN
05
—
0582874
—
IA
05
—
200466780A
—
IN
Enumeration date
04/03/2006
Last updated
06/17/2008
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