Provider Demographics
NPI:1407844392
Name:JAY-MED INC.
Entity type:Organization
Organization Name:JAY-MED INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:605-997-2122
Mailing Address - Street 1:127 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-1222
Mailing Address - Country:US
Mailing Address - Phone:605-997-2122
Mailing Address - Fax:605-997-5408
Practice Address - Street 1:127 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1222
Practice Address - Country:US
Practice Address - Phone:605-997-2122
Practice Address - Fax:605-997-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1000960332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4303979OtherNABP #
SD8503080Medicaid
SD0698570001Medicare ID - Type Unspecified