Provider Demographics
NPI:1740377068
Name:JOVIC MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:JOVIC MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GBENJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-709-3207
Mailing Address - Street 1:12525 FONDREN RD STE I
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-5226
Mailing Address - Country:US
Mailing Address - Phone:281-709-3207
Mailing Address - Fax:713-771-4784
Practice Address - Street 1:12525 FONDREN RD STE I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5226
Practice Address - Country:US
Practice Address - Phone:281-709-3207
Practice Address - Fax:713-771-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXD0013711332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies