NPIMap

Organization Active NPI

Jacobs Medical Supply,LLC

  • Durable Medical Equipment & Medical Supplies
  • Elk Grove, CA
National Provider Identifier
1124386495
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
201013710108 Issued in CA
Legal business name
JACOBS MEDICAL SUPPLY,LLC
Practice address
8213 Crichton Way
Elk Grove, CA 95758-8028
Phone
(916) 647-4193
Fax
(916) 896-5115
NPI assigned
Apr 24, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Authorized official

Name
Mr. Jerry Valera Neria
Title
President
Phone
(916) 647-4193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 201013710108 CA Primary

Addresses

Primary practice location

8213 Crichton Way
Elk Grove, CA 95758-8028

Mailing address

8213 Crichton Way
Elk Grove, CA 95758-8028
Phone (916) 647-4193

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1124386495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8213 CRICHTON WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588028",
            "telephone_number": "916-647-4193",
            "fax_number": "916-896-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8213 CRICHTON WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588028",
            "telephone_number": "916-647-4193",
            "fax_number": "916-896-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBS MEDICAL SUPPLY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "NERIA",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "VALERA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-647-4193",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "201013710108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.