Provider Demographics
NPI:1215753330
Name:JK MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:JK MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-222-5829
Mailing Address - Street 1:6569 EDSALL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4414
Mailing Address - Country:US
Mailing Address - Phone:571-222-5829
Mailing Address - Fax:571-351-6081
Practice Address - Street 1:6569 EDSALL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4414
Practice Address - Country:US
Practice Address - Phone:571-222-5829
Practice Address - Fax:571-351-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies