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General NPI Number Information
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NPI Number | 1760696926
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Entity Type | Organization
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Legal Business Name | JUMP START U TOO
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4120 MAIN ST
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City | COLUMBIA
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State | SC
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Zip | 29203-5862
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Country | US
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Telephone | 803-691-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 MAIN ST
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City | COLUMBIA
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State | SC
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Zip | 29203-5862
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Country | US
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Telephone | 803-691-0096
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KATIE L. RILEY
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Credential | BS
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Telephone | 803-691-0096
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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 | 062724-2
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License Number State | SC
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