Provider Demographics
NPI:1265837165
Name:LJ MEDICAL
Entity type:Organization
Organization Name:LJ MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:520-979-1915
Mailing Address - Street 1:2550 E LIND RD
Mailing Address - Street 2:27
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1538
Mailing Address - Country:US
Mailing Address - Phone:520-979-1915
Mailing Address - Fax:
Practice Address - Street 1:2550 E LIND RD
Practice Address - Street 2:27
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1538
Practice Address - Country:US
Practice Address - Phone:520-979-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3033196332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies