Provider Demographics
NPI:1912932864
Name:JE MED SUPPLIES AND SERVICES LC
Entity type:Organization
Organization Name:JE MED SUPPLIES AND SERVICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-947-3499
Mailing Address - Street 1:3440 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7004
Mailing Address - Country:US
Mailing Address - Phone:239-947-3499
Mailing Address - Fax:239-947-4428
Practice Address - Street 1:3440 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7004
Practice Address - Country:US
Practice Address - Phone:239-947-3499
Practice Address - Fax:239-947-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1343332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4123440001Medicare ID - Type UnspecifiedMEDICARE