Organization
JACKSON MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY ANN WIGMORE RN (OWNER)
(707) 446-7014
Entity
Organization
Contact information
Practice address
506 MAIN ST, VACAVILLE, CA 95688-3922
(707) 446-7014
(707) 446-1871
Mailing address
506 MAIN ST, VACAVILLE, CA 95688-3922
(707) 446-7014
(707) 446-1871
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
103834
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03183F
—
CA
Enumeration date
01/12/2010
Last updated
06/29/2010
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