Provider Demographics
NPI:1609074194
Name:JC MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:JC MEDICAL SUPPLIES INC
Other - Org Name:JC MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGELEKE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:702-870-2850
Mailing Address - Street 1:4015 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1612
Mailing Address - Country:US
Mailing Address - Phone:702-870-2850
Mailing Address - Fax:702-870-5460
Practice Address - Street 1:4015 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1612
Practice Address - Country:US
Practice Address - Phone:702-870-2850
Practice Address - Fax:702-870-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5999660001Medicare NSC