Jack City, LLC
Durable Medical Equipment & Medical Supplies in Watertown, Massachusetts
1376002931- Practice location
- 30 Center St, Watertown, MA 02472-4018
- Phone
- 617-393-1709
- Fax
- 617-754-6420
- Last updated
- April 20, 2026
Jack City, LLC is a healthcare organization based in Watertown, MA. Jack City, LLC practices in Watertown, MA. The NPI Number for Jack City, LLC is 1376002931. The current practice location address for Jack City, LLC is 30 Center St, Watertown, MA 02472-4018 and can be reached out via phone at 617-393-1709 and via fax at 617-754-6420.
Provider Profile Details
- NPI Number
- 1376002931
- Provider Name
- Jack City, LLC
- Provider Entity Type
- Organization
- Address
- 30 Center St, Watertown, MA 02472-4018
- Phone Number
- 617-393-1709
- Fax Number
- 617-754-6420
- Primary Taxonomy
- Durable Medical Equipment & Medical Supplies · 332B00000X
- Organization Subpart
- No
- Authorized Official
- Codey Gillum, PA-C · Ceo · 617-754-5000
- Provider Enumeration Date
- March 13, 2019
- Last Update Date
- April 20, 2026
- Certification Date
- April 20, 2026
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 30 Center St
Watertown, MA 02472-4018 - City
- Watertown
- State
- Massachusetts
- Zip
- 02472-4018
- Phone Number
- 617-393-1709
- Fax Number
- 617-754-6420
Provider Business Mailing Address Details
- Address
- 30 Center St
Watertown, MA 02472-4018 - City
- Watertown
- State
- MA
- Zip
- 02472-4018
- Phone Number
- 857-760-7374
- Fax Number
- 617-754-6420
License Information
- Taxonomy (1)
- Physician Assistant, Surgical · 363AS0400X
- Taxonomy (2)
- Durable Medical Equipment & Medical Supplies · 332B00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Jack City, LLC?
The NPI number of Jack City, LLC is 1376002931. It was assigned on March 13, 2019 and is currently active in the NPPES registry.
What is the specialty of Jack City, LLC?
Jack City, LLC is registered under the primary taxonomy Durable Medical Equipment & Medical Supplies (code 332B00000X).
Where does Jack City, LLC practice?
The practice location is 30 Center St, Watertown, MA 02472-4018. The office can be reached at 617-393-1709 (phone) or 617-754-6420 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1376002931 directly on the NPPES registry website.