MEDICARE: JEFFERSON 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1467988592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	4365 RITTIMAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3663
Country	:	US
Telephone Number	:	210-946-8200
Fax Number	:	210-946-8204

Provider Business Practice Location Address
First Line	:	4365 RITTIMAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3663
Country	:	US
Telephone Number	:	210-946-8200
Fax Number	:	210-946-8204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RIGOBERTO D'LEON
Credential	:
Telephone Number	:	210-946-8200

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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