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General NPI Number Information
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NPI Number | 1417941774
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Entity Type | Organization
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Legal Business Name | J&B MEDICAL SUPPLY CO INC
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 50496 W. PONTIAC TRL
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City | WIXOM
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State | MI
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Zip | 48393-2027
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Country | US
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Telephone | 800-737-0045
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Fax | 800-737-0012
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Provider Business Mailing Address
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Address Line | 50496 W. PONTIAC TRL
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City | WIXOM
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State | MI
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Zip | 48393-2027
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Country | US
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Telephone | 800-737-0045
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Fax | 800-737-0012
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Authorized Official
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Title or Position | V.P.
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Name | MR. JULIAN SHAYA
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Credential |
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Telephone | 248-360-9977
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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 | B ME-0145457
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License Number State | MI
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