Provider Demographics
NPI:1043557044
Name:SJM SUPPLIES INC
Entity Type:Organization
Organization Name:SJM SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOISSELT
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-610-0656
Mailing Address - Street 1:PO BOX 5167
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-5167
Mailing Address - Country:US
Mailing Address - Phone:787-610-0656
Mailing Address - Fax:
Practice Address - Street 1:MAIN ST 116
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-0000
Practice Address - Country:US
Practice Address - Phone:787-610-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFOR MEDICARE