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General NPI Number Information
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NPI Number | 1457520215
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Entity Type | Organization
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Legal Business Name | JSC II, LLC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 440 OLD DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-3410
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Country | US
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Telephone | 314-291-3377
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Fax | 314-291-3378
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Provider Business Mailing Address
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Address Line | 440 OLD DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-3410
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Country | US
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Telephone | 314-291-3377
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Fax | 314-291-3378
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MELINDA K TRUSTY
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Credential |
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Telephone | 314-291-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 801
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License Number State | IL
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