MEDICARE: J MEDICAL

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

General Provider Information

NPI Number	:	1073841953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J MEDICAL

Provider Business Mailing Address
First Line	:	9616 HAMILTON HILLS DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2070
Country	:	US
Telephone Number	:	317-594-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	9616 HAMILTON HILLS DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2070
Country	:	US
Telephone Number	:	317-594-0094
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER/OPERATOR
Name	:	MR. BRAD DEAN JAMES
Credential	:
Telephone Number	:	317-594-0094

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	03/14/2012

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1598591489 — CASSIDY SHIRLEY DMS, PA-C
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Directions to “J MEDICAL ” Practice Location

Language	Start Address	Practice Location

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