Provider Demographics
NPI:1831154665
Name:JM MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:JM MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-608-1779
Mailing Address - Street 1:8900 BENSON AVE
Mailing Address - Street 2:STE. L
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1669
Mailing Address - Country:US
Mailing Address - Phone:909-608-1779
Mailing Address - Fax:
Practice Address - Street 1:8900 BENSON AVE
Practice Address - Street 2:STE. L
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1669
Practice Address - Country:US
Practice Address - Phone:909-608-1779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0885210001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02182FMedicaid
CADME02182FMedicaid