Provider Demographics
NPI:1124268081
Name:JHORDAN MEDICAL SUPPLY
Entity type:Organization
Organization Name:JHORDAN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTHIEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-249-7370
Mailing Address - Street 1:PO BOX 260155
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-0155
Mailing Address - Country:US
Mailing Address - Phone:813-249-7370
Mailing Address - Fax:813-249-7370
Practice Address - Street 1:7307 ABONADO RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2415
Practice Address - Country:US
Practice Address - Phone:813-249-7370
Practice Address - Fax:813-886-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies