Provider Demographics
NPI:1750648770
Name:J MEDICAL BRACING LLC
Entity Type:Organization
Organization Name:J MEDICAL BRACING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-679-4507
Mailing Address - Street 1:450 E 96TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-5703
Mailing Address - Country:US
Mailing Address - Phone:317-863-0922
Mailing Address - Fax:317-405-9697
Practice Address - Street 1:450 E 96TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-5703
Practice Address - Country:US
Practice Address - Phone:317-863-0922
Practice Address - Fax:317-405-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-15
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies