MEDICARE: JACKSON MEDICAL SERVICES

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	DME02720F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114929437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2930B HILLTOP MALL RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-1902
Country	:	US
Telephone Number	:	510-222-1075
Fax Number	:	510-222-1575

Provider Business Practice Location Address
First Line	:	2930B HILLTOP MALL RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-1902
Country	:	US
Telephone Number	:	510-222-1075
Fax Number	:	510-222-1575

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW JACKSON
Credential	:
Telephone Number	:	510-222-1075

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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Directions to “JACKSON MEDICAL SERVICES ” Practice Location

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