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General NPI Number Information
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NPI Number | 1073221552
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Entity Type | Organization
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Legal Business Name | J&G MEDICAL SUPPLIES
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2011 S 25TH ST STE 209
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City | FORT PIERCE
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State | FL
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Zip | 34947-4748
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Country | US
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Telephone | 772-672-4409
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 S 25TH ST STE 209
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City | FORT PIERCE
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State | FL
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Zip | 34947-4748
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Country | US
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Telephone | 772-672-4409
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JUNIOR GRACIA
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Credential |
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Telephone | 772-353-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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