Provider Demographics
NPI:1063443943
Name:JT MEDICAL SUPPLY CORPORATION
Entity Type:Organization
Organization Name:JT MEDICAL SUPPLY CORPORATION
Other - Org Name:JT MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RECIO
Authorized Official - Last Name:PARINAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN
Authorized Official - Phone:510-300-1336
Mailing Address - Street 1:20980 REDWOOD RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5930
Mailing Address - Country:US
Mailing Address - Phone:510-300-1330
Mailing Address - Fax:510-300-1336
Practice Address - Street 1:20980 REDWOOD RD
Practice Address - Street 2:SUITE 260
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5930
Practice Address - Country:US
Practice Address - Phone:510-300-1330
Practice Address - Fax:510-300-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45340332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5695340001Medicare NSC
BO8006333Medicare Oscar/Certification