Provider Demographics
NPI:1013198662
Name:LIVERMORE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:LIVERMORE MEDICAL SUPPLIES
Other - Org Name:LIVE-MORE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROTHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-788-1193
Mailing Address - Street 1:3989 FOOTHILLS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747
Mailing Address - Country:US
Mailing Address - Phone:916-788-1193
Mailing Address - Fax:916-788-0982
Practice Address - Street 1:3989 FOOTHILLS BLVD
Practice Address - Street 2:STUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:916-788-1193
Practice Address - Fax:916-788-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies