Active NPI
Michael Jackson
- Durable Medical Equipment & Medical Supplies
- Garden City, ID
National Provider Identifier
1801365382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- NA
- Practice address
- 5537B N Glenwood St Ste B
Garden City, ID 83714-1336 - Phone
- (208) 789-9075
- Fax
- (208) 917-2818
- NPI assigned
- Nov 14, 2018
- Last updated
- Nov 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NA | ID | Primary |
Addresses
Primary practice location
5537B N Glenwood St Ste B
Garden City, ID 83714-1336
Mailing address
PO Box 326
Meridian, ID 83680-0326
Phone (208) 890-9750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542153600000",
"number": "1801365382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 326",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836800326",
"telephone_number": "208-890-9750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5537B N GLENWOOD ST STE B",
"city": "GARDEN CITY",
"state": "ID",
"postal_code": "837141336",
"telephone_number": "208-789-9075",
"fax_number": "208-917-2818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-14",
"last_updated": "2018-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "ID",
"license": "NA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, ID
- Ida-Ore Planning & Development Association, Inc. (Idaho Council of Governments/ Area Agency on Aging)
- Ikdo State Street LLC
- Imperial Transport LLC
- Imperial Transport LLC
- Issaura Potter, LLC
- Jeppe Chiropractic PLLC
- Kim Johnson, PHARMD
- Rebecca L Johnston, LCSW
- Kat Bowen Counseling PLLC
- Kelsey Ruszel, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.