Provider Demographics
NPI:1164591665
Name:J.D. MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:J.D. MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:LUPONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-371-0814
Mailing Address - Street 1:121 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1593
Mailing Address - Country:US
Mailing Address - Phone:412-371-0814
Mailing Address - Fax:412-371-0816
Practice Address - Street 1:121 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1593
Practice Address - Country:US
Practice Address - Phone:412-371-0814
Practice Address - Fax:412-371-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4337620001Medicare NSC