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NPI Code Detail

MEDICARE: JACKSON MEDICAL SUPPLY INC

MEDICARE: JACKSON MEDICAL SUPPLY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies53312CA

General Provider Information

NPI Number : 1104136126
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSON MEDICAL SUPPLY INC
Provider Business Mailing Address
First Line : 604 MAIN ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-3405
Country : US
Telephone Number : 530-661-7409
Fax Number : 530-661-7345
Provider Business Practice Location Address
First Line : 604 MAIN ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-3405
Country : US
Telephone Number : 530-661-7409
Fax Number : 530-661-7345
Authorized Official
Title or Position : OWNER CFO
Name : MS. WENDY ANN WIGMORE
Credential :
Telephone Number : 707-446-7014
Provider Enumeration Date : 10/08/2010
Last Update Date : 10/08/2010

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Directions to “JACKSON MEDICAL SUPPLY INC ” Practice Location

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