Provider Demographics
NPI:1093277485
Name:AMERICAN SURGICAL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:AMERICAN SURGICAL MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDNET
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:LAFAYETTE
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:III
Authorized Official - Credentials:RTS
Authorized Official - Phone:760-599-8800
Mailing Address - Street 1:6965 EL CAMINO REAL # 105-253
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4100
Mailing Address - Country:US
Mailing Address - Phone:760-599-8800
Mailing Address - Fax:760-599-8844
Practice Address - Street 1:24735 REDLANDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4033
Practice Address - Country:US
Practice Address - Phone:866-611-7205
Practice Address - Fax:909-366-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier