Provider Demographics
NPI:1093744732
Name:FAMILY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:FAMILY MEDICAL SUPPLY
Other - Org Name:FAMILY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OGANES
Authorized Official - Middle Name:
Authorized Official - Last Name:MADARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-9974
Mailing Address - Street 1:6164 1/4 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2503
Mailing Address - Country:US
Mailing Address - Phone:818-997-9974
Mailing Address - Fax:818-997-9978
Practice Address - Street 1:6164 1/4 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2503
Practice Address - Country:US
Practice Address - Phone:818-997-9974
Practice Address - Fax:818-997-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA761667-13332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4674580001Medicare NSC