Provider Demographics
NPI:1003461237
Name:CAPITOL MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:CAPITOL MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICERR
Authorized Official - Prefix:
Authorized Official - First Name:KAMERIA
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-753-9368
Mailing Address - Street 1:1160 LAKE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3506
Mailing Address - Country:US
Mailing Address - Phone:719-208-7573
Mailing Address - Fax:204-410-2597
Practice Address - Street 1:1160 LAKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3506
Practice Address - Country:US
Practice Address - Phone:719-208-7573
Practice Address - Fax:204-410-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies