Basic Information
| Provider Information | |||||||||
| NPI: | 1194445239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JRK MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559035865 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 VILLAGE CENTER DR STE 800 | ||||||||
| Address2: | |||||||||
| City: | NORTH OAKS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551277201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073226900 | ||||||||
| FaxNumber: | 5073226967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | KALSI | ||||||||
| AuthorizedOfficialFirstName: | HENNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER (MEDICAL DIRECTOR) | ||||||||
| AuthorizedOfficialTelephone: | 5073326900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.