MICHAEL JACKSON
Individual Provider (NPI-1)
Active
Durable Medical Equipment & Medical Supplies
Provider Information
- NPI Number
1801365382- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 5537B N GLENWOOD ST STE B, GARDEN CITY, ID, 837141336
- Phone
- (208) 789-9075
- Fax
- (208) 917-2818
Specialties & Taxonomies
Durable Medical Equipment & Medical Supplies
Primary License: ID #NA