Jackson Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

103834 Issued in CA

Legal business name

JACKSON MEDICAL SUPPLY INC

Practice address

506 Main St
Vacaville, CA 95688-3922

Phone

(707) 446-7014

Fax

(707) 446-1871

NPI assigned

Jan 12, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Wendy Ann Wigmore, RN

Title

Owner

Phone

(707) 446-7014

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Jackson Medical Supply Inc

  • Durable Medical Equipment & Medical Supplies
  • Vallejo, CA
  • NPI 1578873592

  4880884600

  Same PAC ID

Locations

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Jackson Medical Supply Inc

  • Durable Medical Equipment & Medical Supplies
  • Woodland, CA
  • NPI 1104136126
  NPPES parent name
• Jackson Medical Supply Inc

  • Durable Medical Equipment & Medical Supplies
  • Vallejo, CA
  • NPI 1578873592
  NPPES parent name

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1386974491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 MAIN ST",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956883922",
            "telephone_number": "707-446-7014",
            "fax_number": "707-446-1871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 MAIN ST",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956883922",
            "telephone_number": "707-446-7014",
            "fax_number": "707-446-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-12",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "WIGMORE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-446-7014",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "103834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03183F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Quinn Iwanicki
• Sharon Izen-Tengbergen, M.F.T.
• Zelikha Izmarai
• Aileen J. Jaber, MD
• Jackman Family Dentistry
• Amanda Jackson, MD
• Kathryn Lano Jackson, NURSE PRACTITIONER
• Njaya Jackson
• Serina Rene Jackson, ASW
• Jeanette Mina Jacobe, A.B

• Durable Medical Equipment & Medical Supplies in Vacaville, CA
• Providers in Vacaville, 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 Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.