Provider Demographics
NPI:1467699801
Name:JDM MEDICAL,INC.
Entity Type:Organization
Organization Name:JDM MEDICAL,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DONAHUE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:850-995-0382
Mailing Address - Street 1:4562 CHUMUCKLA HWY
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1004
Mailing Address - Country:US
Mailing Address - Phone:850-995-0382
Mailing Address - Fax:850-995-4116
Practice Address - Street 1:4562 CHUMUCKLA HWY
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1004
Practice Address - Country:US
Practice Address - Phone:850-995-0382
Practice Address - Fax:850-995-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment