Provider Demographics
NPI:1326881921
Name:J&B MEDICAL SUPPLY CO INC
Entity type:Organization
Organization Name:J&B MEDICAL SUPPLY CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-737-0045
Mailing Address - Street 1:50496 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2088
Mailing Address - Country:US
Mailing Address - Phone:800-737-0045
Mailing Address - Fax:800-737-0012
Practice Address - Street 1:194 E HIGHWAY 66 STE A
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6232
Practice Address - Country:US
Practice Address - Phone:800-737-0045
Practice Address - Fax:800-737-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies