Provider Demographics
NPI:1285092585
Name:JW DURABLE MECICAL EQUIPMENT
Entity type:Organization
Organization Name:JW DURABLE MECICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-473-4343
Mailing Address - Street 1:343 ALVARADO ST STE A
Mailing Address - Street 2:
Mailing Address - City:FALLBROK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2966
Mailing Address - Country:US
Mailing Address - Phone:760-473-4343
Mailing Address - Fax:
Practice Address - Street 1:343 E ALVARADO ST STE A
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2966
Practice Address - Country:US
Practice Address - Phone:760-473-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies