Organization Name: | JACKSON MEDICAL SUPPLY INC |
NPI Number: | 1578873592 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WENDY ANN WIGMORE (OWNER, CFO) |
Mailing Address: | 480 Redwood St # 44 Vallejo |
State: | CA US |
Postal Code: | 945902958 |
Phone Number: | 7076444170 |
Fax Number: | 7076444163 |
NPI Enumeration Date: | 10/08/2010 |
NPI Last Update Date: | 10/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 53238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |