Healthcare Provider Details

I. General information

NPI: 1285214700
Provider Name (Legal Business Name): JAM HEALTHCARE SERVICES SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL STE 41
ORLANDO FL
32805-3138
US

IV. Provider business mailing address

750 S ORANGE BLOSSOM TRL STE 41
ORLANDO FL
32805-3138
US

V. Phone/Fax

Practice location:
  • Phone: 407-801-2863
  • Fax: 407-350-3185
Mailing address:
  • Phone: 407-801-2863
  • Fax: 407-350-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JUANITA MARTIN
Title or Position: CEO
Credential:
Phone: 407-801-2863