=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114975620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMR MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9821 OLDE 8 RD STE D1
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44067-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-474-9912
-----------------------------------------------------
Fax | 330-467-1839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 E NORTH LN STE 5075
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CCO
-----------------------------------------------------
Name | WENDY RUSSALESI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-246-9499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | HMEL.11025
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------