Provider Demographics
NPI:1316996754
Name:JRS MEDICAL SUPPLY & OXYGEN INC
Entity type:Organization
Organization Name:JRS MEDICAL SUPPLY & OXYGEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-380-5005
Mailing Address - Street 1:PO BOX 2481
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-2481
Mailing Address - Country:US
Mailing Address - Phone:407-380-5005
Mailing Address - Fax:407-380-0802
Practice Address - Street 1:8265 VALENCIA COLLEGE LANE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3242
Practice Address - Country:US
Practice Address - Phone:407-380-5005
Practice Address - Fax:407-380-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5880120308977332BP3500X
FL539332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL950264500Medicaid
R7475OtherBCBS OF FLA
FL950264500Medicaid