Provider Demographics
NPI:1932426061
Name:JDS MEDICAL INC
Entity Type:Organization
Organization Name:JDS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNMYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-1248
Mailing Address - Street 1:1625 AIRPORT RD
Mailing Address - Street 2:PO BOX 596
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9749
Mailing Address - Country:US
Mailing Address - Phone:740-342-5158
Mailing Address - Fax:740-342-6702
Practice Address - Street 1:1625 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9749
Practice Address - Country:US
Practice Address - Phone:740-342-5158
Practice Address - Fax:740-342-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075041D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363829OtherPTN