Provider Demographics
NPI:1619253713
Name:J&J MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:J&J MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMI
Authorized Official - Middle Name:BALURAN
Authorized Official - Last Name:HERMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-349-1059
Mailing Address - Street 1:6900 E GREEN LAKE WAY N APT 120
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5495
Mailing Address - Country:US
Mailing Address - Phone:206-371-3503
Mailing Address - Fax:
Practice Address - Street 1:24908 107TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5634
Practice Address - Country:US
Practice Address - Phone:206-349-1059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60314741621332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies