JACKSON MEDICAL SUPPLY INC (NPI# 1578873592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578873592 |
| Entity Type | Organization |
| Organization Name | JACKSON MEDICAL SUPPLY INC |
| Other Organization Name | JACKSON MEDICAL SUPPLY |
| Practice Address |
480 Redwood St # 44 Vallejo CA 94590-2958 |
| Practice Telephone | 7076444170 |
| Practice Fax Number | 7076444163 |
| Mailing Telephone | 7076444170 |
| Mailing Fax Number | 7076444163 |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2010-10-08 |
| Authorized Official Name | MS. WENDY ANN WIGMORE (OWNER, CFO) |
| Authorized Official Telephone | 7074467014 |
| Is Organization Subpart | Y |
| Parent Organization Name | JACKSON MEDICAL SUPPLY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | 53238 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| JACKSON MEDICAL SUPPLY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104136126 | Jackson Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 604 Main St, Woodland, CA 95695-3405 | 2010-10-08 |
| 1386974491 | Jackson Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 506 Main St, Vacaville, CA 95688-3922 | 2010-01-12 |
| 1386813806 | Jackson Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 2147 Henry Hill Dr, Ste 109, Jackson, MS 39204-2001 | 2008-02-28 |
| Street Address |
480 REDWOOD ST # 44 |
| City | VALLEJO |
| State | CA |
| Zip Code | 94590-2958 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730167370 | Paul David Weiner | Podiatrist | 480 Redwood St, Suite 10, Vallejo, CA 94590-2958 | 2006-01-04 |
| 1801258330 | Dental Office of Mounir N. Guirguis Dds, Inc. | Dentist | 480 Redwood St, Suite #13, Vallejo, CA 94590-2958 | 2016-03-23 |
| 1912323155 | Mercury Pharmacy Corporation | Pharmacy | 480 Redwood St, Suite#33, Vallejo, CA 94590-2958 | 2014-03-12 |
| 1790100519 | Teri Bilhartz Medical Corporation | Preventive Medicine | 480 Redwood St, Suite 14, Vallejo, CA 94590-2958 | 2014-03-03 |
| 1609187392 | Ryan Christian Thomas | Podiatrist | 480 Redwood St, Suite 10, Vallejo, CA 94590-2958 | 2010-06-28 |
| 1063737609 | Setty Dds Inc. | Dentist | 480 Redwood St, Suite 13, Vallejo, CA 94590-2958 | 2010-04-06 |
| 1326372608 | Ricardo Angel Duenas | Pharmacist | 480 Redwood St, Suite#33, Vallejo, CA 94590-2958 | 2009-09-19 |
| 1730350422 | Paul David Weiner | Podiatrist | 480 Redwood St, Suite 10, Vallejo, CA 94590-2958 | 2008-03-20 |
| 1386825750 | Laurence J. Mazzotta Md PC | Internal Medicine | 480 Redwood St, Suite 14, Vallejo, CA 94590-2958 | 2007-11-14 |
| 1023182425 | Denise L. Martin-sahim | Specialist | 480 Redwood St, Suite 14, Vallejo, CA 94590-2958 | 2006-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265051445 | Jaspreet Bains | Licensed Vocational Nurse | 508 Alabama Street, Vallejo, CA 94590 | 2020-04-08 |
| 1467097527 | Deneane Hannon | Behavioral Analyst | 238 Georgia St. Ste 102, Vallejo, CA 94590 | 2019-11-13 |
| 1780243196 | Abla Harara Almoraissi | Health Educator | John F. Kennedy Library, 505 Santa Clara St, Vallejo, CA 94590 | 2019-06-10 |
| 1891264461 | Brian Emory Kellogg | Marriage & Family Therapist | 525 Oregon St., Php/iop, Vallejo, CA 94590 | 2018-11-13 |
| 1952801862 | Carica Theresa Saraza Macariola | Specialist/Technologist | 1007 Solano Avenue, Vallejo, CA 94590 | 2018-02-16 |
| 1770007973 | Deborah A Johnson-white | Licensed Vocational Nurse | 908 Tuolumne, Vallejo, CA 94590 | 2017-07-29 |
| 1306378260 | Edgar Diaz | Counselor | 236 Georgia Street Suite 101, Vallejo, CA 94590 | 2017-03-30 |
| 1528440096 | Soren Perry | Counselor | 236 Georgia St., Vallejo, CA 94590 | 2015-06-22 |
| 1518366327 | Kimberly A Holland | Counselor | 631 Tennessee Street Suite 201, Vallejo, CA 94590 | 2014-08-18 |
| 1841605193 | Lawana Lofton | Psychologist | 88 Valle Vista Drive, Unit 6310, Vallejo, CA 94590 | 2014-06-25 |
| Find all providers in zip 94590 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235566944 | Ultracare Medical Supply | Durable Medical Equipment & Medical Supplies | 431 Trotter Dr, Vallejo, CA 94591-8512 | 2013-09-27 |
| 1356787170 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 501 Sereno Dr, Vallejo, CA 94589-2460 | 2013-05-20 |
| 1366718322 | Jennie G Holohan | Durable Medical Equipment & Medical Supplies | 55 Springstowne Ctr # 305, Vallejo, CA 94591-5566 | 2012-03-23 |
| 1518011329 | Wendy A. Wigmore | Durable Medical Equipment & Medical Supplies | 480 Redwood St Ste 44, Vallejo, CA 94590-2958 | 2007-01-22 |
| 1407920556 | Hanger Prosthetics & Orthotics West, Inc. | Durable Medical Equipment & Medical Supplies | 1460 N Camino Alto Ste 106, Vallejo, CA 94589-2567 | 2006-11-20 |
| 1184708372 | All Medical Supply & Equipment LLC | Durable Medical Equipment & Medical Supplies | 921 Marin St, Vallejo, CA 94590-5431 | 2006-10-24 |
| 1972612323 | Thrifty Payless Inc | Durable Medical Equipment & Medical Supplies | 2021 Solano Avenue, Solano 80 Shopping Center, Vallejo, CA 94590-6456 | 2006-08-30 |
| 1023023306 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1050 Redwood St, Vallejo, CA 94590-2955 | 2006-07-29 |
| 1609881986 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2647 Springs Rd, Vallejo, CA 94591-5712 | 2006-07-29 |
| 1326074105 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 122 Robles Way, Vallejo, CA 94591-8039 | 2006-06-24 |
| Find all providers in VALLEJO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.