MEDICARE: JD MEDICAL SUPPLIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0054375	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013915198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JD MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	407 GILMER RD
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-4622
Country	:	US
Telephone Number	:	903-297-5524
Fax Number	:	903-234-8809

Provider Business Practice Location Address
First Line	:	407 GILMER RD
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-4622
Country	:	US
Telephone Number	:	903-297-5524
Fax Number	:	903-234-8809

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GAIL MCBRIDE
Credential	:
Telephone Number	:	903-297-5524

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/26/2013

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Directions to “JD MEDICAL SUPPLIES, INC. ” Practice Location

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