Provider Demographics
NPI:1568798817
Name:JB MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:JB MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CFTS
Authorized Official - Phone:812-228-6222
Mailing Address - Street 1:815 JOHN ST
Mailing Address - Street 2:SUITE 120 B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2746
Mailing Address - Country:US
Mailing Address - Phone:812-491-8300
Mailing Address - Fax:
Practice Address - Street 1:815 JOHN ST
Practice Address - Street 2:SUITE 120 B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2746
Practice Address - Country:US
Practice Address - Phone:812-491-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000526A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN69000526AOtherHOME MEDICAL EQUIPMENT SERVICE PROVIDER
IN69000526AOtherHOME MEDICAL EQUIPMENT SERVICE PROVIDER