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General NPI Number Information
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NPI Number | 1336209501
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Entity Type | Organization
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Legal Business Name | JIM DANDY MEDICAL INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 3562 KNICKERBOCKER RD
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City | SAN ANGELO
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State | TX
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Zip | 76904-7611
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Country | US
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Telephone | 325-949-9956
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Fax | 325-223-2933
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Provider Business Mailing Address
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Address Line | 3562 KNICKERBOCKER RD
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City | SAN ANGELO
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State | TX
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Zip | 76904-7611
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Country | US
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Telephone | 325-949-9956
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Fax | 325-223-2933
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSIE RAY
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Credential |
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Telephone | 210-643-1044
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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 | 0088157
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License Number State | TX
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