=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821167362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & J MEDICARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 LOVERS LN
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43953-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-266-6118
-----------------------------------------------------
Fax | 740-264-8898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 LOVERS LN
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43953-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-266-6118
-----------------------------------------------------
Fax | 740-264-8898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAMES J BOLGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-266-6118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------