Jackson Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

53312 Issued in CA

Legal business name

JACKSON MEDICAL SUPPLY INC

Practice address

604 Main St
Woodland, CA 95695-3405

Phone

(530) 661-7409

Fax

(530) 661-7345

NPI assigned

Oct 8, 2010

Organization subpart

Yes

Parent organization

JACKSON MEDICAL SUPPLY INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Wendy Ann Wigmore

Title

Owner Cfo

Phone

(707) 446-7014

Specialties & licenses 1

Addresses

Other names 1

• JACKSON MEDICAL SUPPLY Doing business as

Part of

Jackson Medical Supply Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Jackson Medical Supply Inc

  • Durable Medical Equipment & Medical Supplies
  • Vacaville, CA
  • NPI 1386974491
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286496000000",
    "number": "1104136126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 MAIN ST",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956953405",
            "telephone_number": "530-661-7409",
            "fax_number": "530-661-7345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 MAIN ST",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956953405",
            "telephone_number": "530-661-7409",
            "fax_number": "530-661-7345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL SUPPLY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON MEDICAL SUPPLY INC",
        "enumeration_date": "2010-10-08",
        "last_updated": "2010-10-08",
        "status": "A",
        "authorized_official_last_name": "WIGMORE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER CFO",
        "authorized_official_telephone_number": "707-446-7014",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "53312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON MEDICAL SUPPLY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Skye Keeley-Shea Innerarity, M.A.
• Paula Insigne
• Ailene Isles Isleta-Florento, M.D.
• Eaman Nabil Mohamed Ismail, RPH
• Ja.Corp
• Sheryl Ann Jackson, RN
• Monica Caron Jackura, OT
• Demetrius Jacobs
• Anna Jacquez, B.S.
• Marie Elena Jaime

• Durable Medical Equipment & Medical Supplies in Woodland, CA
• Providers in Woodland, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.