1174543912 NPI number — XTREME MEDICAL INC

Table of content: (NPI 1174543912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174543912 NPI number — XTREME MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
XTREME MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1174543912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GORMAN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93243-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-248-6260
Provider Business Mailing Address Fax Number:
661-248-6270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49744 GORMAN POST RD
Provider Second Line Business Practice Location Address:
4
Provider Business Practice Location Address City Name:
GORMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93243-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-248-6260
Provider Business Practice Location Address Fax Number:
661-248-6270
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALGADO
Authorized Official First Name:
BART
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-803-9444

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 796130800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9167760 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2182070 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME03181F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582154 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30760747 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90001231 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9049438 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200854070A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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