=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225278336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE J2 COMMERCIAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2009
-----------------------------------------------------
Last Update Date | 03/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 S DALE MABRY HWY STE A1
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33629-5837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-265-2225
-----------------------------------------------------
Fax | 888-361-0637
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13903 CAPTAINS REEF CT
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33624-2599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-425-3521
-----------------------------------------------------
Fax | 888-361-0637
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEFFREY LEWIS STITES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-425-3521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------