Provider Demographics
NPI:1093950206
Name:J.R.B.SUPPLY INC.
Entity Type:Organization
Organization Name:J.R.B.SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RIOS BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-621-2977
Mailing Address - Street 1:1285 NORTH TELEGRAPH RD
Mailing Address - Street 2:#395
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-621-2977
Mailing Address - Fax:
Practice Address - Street 1:1285 NORTH TELEGRAPH RD
Practice Address - Street 2:#395
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-621-2977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty