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JACK CITY, LLC
NPI 1376002931
Durable Medical Equipment & Medical Supplies in Watertown, MA

Active since March 13, 2019
30 CENTER ST, WATERTOWN, MA 02472(617) 393-1709(617) 754-6420 Get Directions Write a Review

NPPES record last updated: April 20, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 20, 2026, Jan 15, 2026, Dec 20, 2025 and 7 more (10 updates tracked since 2019).

About Jack City, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK CITY, LLC (NPI 1376002931) is a healthcare organization registered as a durable medical equipment & medical supplies in Watertown, Massachusetts and active in the NPI registry since March 2019. The organization maintains 5 additional practice locations and lists Codey Gillum, Ceo, as its authorized official.

NPPES Registry Identity

NPI1376002931
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameJACK CITY, LLC
Location Address30 CENTER STWatertown, MA 02472-4018
Mailing Address30 Center StWatertown, MA 02472-4018 · (857) 760-7374 · Fax (617) 754-6420
Phone(617) 393-1709
Fax(617) 754-6420
Organization SubpartNo
Authorized OfficialCodey GillumCeo · (617) 754-5000
Enumeration DateMarch 13, 2019
Last NPPES UpdateApril 20, 202610 updates tracked since enumeration
NPPES CertifiedApril 20, 2026
✔ NPI 1376002931 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X
30 CENTER ST, Watertown, MA 02472
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Secondary Practice Locations 5

Location 1125 Parker Hill AveBoston, MA 02120-2847 · Phone (617) 754-5000
Location 270 Walnut StWellesley, MA 02481-2135 · Phone (774) 517-7555 · Fax (617) 754-6420
Location 3125 Parker Hill Ave # 4Boston, MA 02120-2847 · Phone (617) 754-6569 · Fax (617) 154-6420
Location 42014 Washington StNewton, MA 02462-1607 · Phone (617) 243-6000
Location 5125 Parker Hill Ave # 550Boston, MA 02120-2847 · Phone (617) 602-5707 · Fax (877) 547-4951

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack City, LLC's NPI number?

The NPI number for Jack City, LLC is 1376002931. It was assigned to this organization in the NPPES registry on March 13, 2019.

Where is Jack City, LLC located?

Jack City, LLC is located at 30 Center St, Watertown, MA 02472. The listed phone number is (617) 393-1709.

What is Jack City, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

When was this NPI record last updated?

The NPPES record for Jack City, LLC was last updated on April 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.