Handicap of Jackson LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

748 Issued in TN

Legal business name

HANDICAP OF JACKSON LLC

Practice address

2088 Hollywood Dr
Jackson, TN 38305-4380

Phone

(731) 660-6116

Fax

(731) 660-6252

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Ty Jones, ATP

Title

Manager

Phone

(731) 660-6116

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1124025465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2088 HOLLYWOOD DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054380",
            "telephone_number": "731-660-6116",
            "fax_number": "731-660-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2088 HOLLYWOOD DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054380",
            "telephone_number": "731-660-6116",
            "fax_number": "731-660-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANDICAP OF JACKSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "731-660-6116",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455080",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN",
            "identifier": "4049264",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Jackson, TN
• Providers in Jackson, TN by specialty
• Durable Medical Equipment & Medical Supplies in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.