1083885768 NPI number — BEACHWOOD MEDICAL SUPPLY, INC

Table of content: (NPI 1083885768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083885768 NPI number — BEACHWOOD MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACHWOOD MEDICAL SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEACHWOOD MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083885768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13851 GARVEY AVE
Provider Second Line Business Mailing Address:
SUITE B3
Provider Business Mailing Address City Name:
BALDWIN PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91706-4910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-338-5300
Provider Business Mailing Address Fax Number:
626-338-5800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13851 GARVEY AVE
Provider Second Line Business Practice Location Address:
SUITE B3
Provider Business Practice Location Address City Name:
BALDWIN PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-338-5300
Provider Business Practice Location Address Fax Number:
626-338-5800
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KALDAS
Authorized Official First Name:
MAHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/RPH
Authorized Official Telephone Number:
626-338-5300

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  49803 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: MP00845 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: 49803 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: MP00845 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 49803 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: MP00845 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 49803 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: MP00845 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 49803 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: MP00845 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MP00845 . This is a "NEVADA STATE BOARD OF PHARMACY, MEDICAL DEVICES, EQUIPMENT, GAS LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 49803 . This is a "HOME MEDICAL DEVICE RETAIL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 152161 . This is a "HOME FURNISHINGS/THERMAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1083885768 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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