1033118609 NPI number — PROMED DME, INC.

Table of content: (NPI 1033118609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033118609 NPI number — PROMED DME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMED DME, 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:
1033118609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10641 CALLE LEE
Provider Second Line Business Mailing Address:
#185
Provider Business Mailing Address City Name:
LOS ALAMITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90720-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-816-7888
Provider Business Mailing Address Fax Number:
714-816-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10641 CALLE LEE
Provider Second Line Business Practice Location Address:
#185
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-816-7888
Provider Business Practice Location Address Fax Number:
714-816-7898
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
RICH
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
CEO/PRES
Authorized Official Telephone Number:
714-816-7888

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  332BX2000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME02976F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com