Provider Demographics
NPI:1467988592
Name:JEFFERSON MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:JEFFERSON MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:D'LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-946-8200
Mailing Address - Street 1:4365 RITTIMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3663
Mailing Address - Country:US
Mailing Address - Phone:210-946-8200
Mailing Address - Fax:210-946-8204
Practice Address - Street 1:4365 RITTIMAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3663
Practice Address - Country:US
Practice Address - Phone:210-946-8200
Practice Address - Fax:210-946-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies