Provider Demographics
NPI:1457520215
Name:JSC II, LLC
Entity Type:Organization
Organization Name:JSC II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRUSTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-291-3377
Mailing Address - Street 1:440 OLD DORSETT RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3410
Mailing Address - Country:US
Mailing Address - Phone:314-291-3377
Mailing Address - Fax:314-291-3378
Practice Address - Street 1:440 OLD DORSETT RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3410
Practice Address - Country:US
Practice Address - Phone:314-291-3377
Practice Address - Fax:314-291-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL801332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid