MEDICARE: JMC HAIRWEAR AND DURABLE MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1194024539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMC HAIRWEAR AND DURABLE MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	2900 W SAMPLE RD
Second Line	:	#2301
City	:	POMPANO BEACH
State	:	FL
Zip	:	33073-3024
Country	:	US
Telephone Number	:	954-975-5760
Fax Number	:	954-766-4416

Provider Business Practice Location Address
First Line	:	2900 W SAMPLE RD
Second Line	:	#2301
City	:	POMPANO BEACH
State	:	FL
Zip	:	33073-3024
Country	:	US
Telephone Number	:	957-975-5760
Fax Number	:	957-766-4416

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARYN LISA DERI
Credential	:
Telephone Number	:	954-975-5760

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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