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General NPI Number Information
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NPI Number | 1033634209
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Entity Type | Organization
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Legal Business Name | JACKSON HEALTH SUPPLIES
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4741 CENTRAL ST. #527
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City | KANSAS
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State | MO
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Zip | 64112
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Country | US
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Telephone | 816-598-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 4741 CENTRAL ST # 527
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City | KANSAS CITY
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State | MO
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Zip | 64112-1533
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Country | US
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Telephone | 816-598-4894
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MOHAMMAD SHAHID
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Credential |
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Telephone | 816-598-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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