Provider Demographics
NPI:1093749277
Name:MGS MEDICAL EQUIPMENT SUPPLIER
Entity Type:Organization
Organization Name:MGS MEDICAL EQUIPMENT SUPPLIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRISDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIRMAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-670-7439
Mailing Address - Street 1:8921 S SEPULVEDA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3650
Mailing Address - Country:US
Mailing Address - Phone:310-670-7439
Mailing Address - Fax:310-670-7465
Practice Address - Street 1:8921 S SEPULVEDA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3650
Practice Address - Country:US
Practice Address - Phone:310-670-7439
Practice Address - Fax:310-670-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000201429000012332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5398410001Medicare NSC