=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063548352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JD & SN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 N 4TH AVE
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-547-5381
-----------------------------------------------------
Fax | 509-543-4954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 PILGRIM ST
-----------------------------------------------------
City | MOSES LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98837-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-764-2314
-----------------------------------------------------
Fax | 509-765-8421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SHAWN WILLIAM NEEDHAM
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 509-764-2314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 601866766
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------