Provider Demographics
NPI:1104851732
Name:MED-DME SUPPLY INC.
Entity Type:Organization
Organization Name:MED-DME SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGUERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-446-0700
Mailing Address - Street 1:8340 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2849
Mailing Address - Country:US
Mailing Address - Phone:818-446-0700
Mailing Address - Fax:818-446-0064
Practice Address - Street 1:8340 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2849
Practice Address - Country:US
Practice Address - Phone:818-446-0700
Practice Address - Fax:818-446-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44983OtherLICENSE NUMBER