Jack City, LLC
NPI #1376002931 in Watertown, Massachusetts
Provider Information
- NPI Number
- 1376002931
- Entity Type
- Organization
- Organization Name
- Jack City, LLC
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- Mar 13, 2019
- Last Updated
- Jan 15, 2026
Practice Location
- Address
- 30 CENTER ST
- City
- Watertown
- State
- Massachusetts
- ZIP Code
- 02472-4018
- Phone
- (617) 393-1709
Authorized Official
- Name
- CODEY GILLUM, PA-C
- Title
- CEO
- Phone
- (617) 754-5000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant - Surgical — Surgical |
| Durable Medical Equipment & Medical Supplies |
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