Provider Demographics
NPI:1407019128
Name:JC MEDICAL SUPPLY
Entity Type:Organization
Organization Name:JC MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNIAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-432-5685
Mailing Address - Street 1:1066 ATLANTIC AVE STE M
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3401
Mailing Address - Country:US
Mailing Address - Phone:562-432-5685
Mailing Address - Fax:562-432-5827
Practice Address - Street 1:1066 ATLANTIC AVE STE M
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3401
Practice Address - Country:US
Practice Address - Phone:562-432-5685
Practice Address - Fax:562-432-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5624560001Medicare NSC