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General NPI Number Information
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NPI Number | 1366449019
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Entity Type | Organization
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Legal Business Name | JS&H ORTHOPEDIC SUPPLY L L C
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 4410 W VICKERY BLVD SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76107-6242
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Country | US
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Telephone | 817-624-0102
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Fax | 817-624-9950
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Provider Business Mailing Address
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Address Line | 4410 W VICKERY BLVD SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76107-6242
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Country | US
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Telephone | 817-624-0102
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Fax | 817-624-9950
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SYLVIA JEAN WILLETT
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Credential |
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Telephone | 817-624-0102
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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 | 0067955A
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License Number State | TX
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