Provider Demographics
NPI:1194024539
Name:JMC HAIRWEAR AND DURABLE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:JMC HAIRWEAR AND DURABLE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:DERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-975-5760
Mailing Address - Street 1:2900 W SAMPLE RD
Mailing Address - Street 2:#2301
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3024
Mailing Address - Country:US
Mailing Address - Phone:954-975-5760
Mailing Address - Fax:954-766-4416
Practice Address - Street 1:2900 W SAMPLE RD
Practice Address - Street 2:#2301
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3024
Practice Address - Country:US
Practice Address - Phone:957-975-5760
Practice Address - Fax:957-766-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies