Jackson Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

53238 Issued in CA

Legal business name

JACKSON MEDICAL SUPPLY INC

Doing business as

Jackson Medical Supply

Practice address

480 Redwood St
# 44
Vallejo, CA 94590-2958

Phone

(707) 644-4170

Fax

(707) 644-4163

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

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
  • Vacaville, CA
  • NPI 1386974491

  4880884600

  Same PAC ID

Part of

Jackson Medical Supply Inc

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": "1578873592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 REDWOOD ST",
            "address_2": "# 44",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902958",
            "telephone_number": "707-644-4170",
            "fax_number": "707-644-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 REDWOOD ST",
            "address_2": "# 44",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902958",
            "telephone_number": "707-644-4170",
            "fax_number": "707-644-4163"
        }
    ],
    "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": "53238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON MEDICAL SUPPLY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J&a Mobility
• J2 Care Collective, LLC
• Raechel Jacala
• Jeremiah Jack, CRNA
• Jackson Initiative LLC
• Amelia G Jackson, LCSW
• Andrew Spencer Jackson, DDS
• April Mary Jackson, PT
• Ashley Nicole Jackson, PHARMD
• Courtney Jackson

• Durable Medical Equipment & Medical Supplies in Vallejo, CA
• Providers in Vallejo, 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.
• 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.