Provider Demographics
NPI:1114975620
Name:JMR MEDICAL, LLC
Entity Type:Organization
Organization Name:JMR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:2084 OTAY LAKES RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1368
Mailing Address - Country:US
Mailing Address - Phone:888-474-9912
Mailing Address - Fax:
Practice Address - Street 1:9821 OLDE 8 RD STE D1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1456
Practice Address - Country:US
Practice Address - Phone:888-474-9912
Practice Address - Fax:330-467-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL.11025332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2200442Medicaid
OHHMEL.11025OtherSTATE LICENSE
OHHMEL.11025OtherSTATE LICENSE