MEDICARE: JUMP START U TOO

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	062724-2	SC

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	:	1760696926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUMP START U TOO

Provider Business Mailing Address
First Line	:	4120 MAIN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5862
Country	:	US
Telephone Number	:	803-691-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 MAIN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5862
Country	:	US
Telephone Number	:	803-691-0096
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KATIE L. RILEY
Credential	:	BS
Telephone Number	:	803-691-0096

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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Directions to “JUMP START U TOO ” Practice Location

Language	Start Address	Practice Location

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