Provider Demographics
NPI:1063548352
Name:JD & SN INC
Entity type:Organization
Organization Name:JD & SN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-764-2314
Mailing Address - Street 1:1555 PILGRIM ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4623
Mailing Address - Country:US
Mailing Address - Phone:509-764-2314
Mailing Address - Fax:509-765-8421
Practice Address - Street 1:1320 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3711
Practice Address - Country:US
Practice Address - Phone:509-547-5381
Practice Address - Fax:509-543-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601866766332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058157Medicaid
WA9058157Medicaid