# JACKSON MEDICAL SUPPLY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386974491
- **Authorized official:** MS. WENDY ANN WIGMORE RN (OWNER)
- **Authorized official phone:** (707) 446-7014

## Contact information

- **Practice address:** 506 MAIN ST, VACAVILLE, CA 95688-3922
- **Practice address phone:** (707) 446-7014
- **Practice address fax:** (707) 446-1871
- **Mailing address:** 506 MAIN ST, VACAVILLE, CA 95688-3922
- **Mailing address phone:** (707) 446-7014
- **Mailing address fax:** (707) 446-1871

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 103834 | CA | Yes |

## Other

- **Enumeration date:** 01/12/2010
- **Last updated:** 06/29/2010