Provider Demographics
NPI:1174044101
Name:PS MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:PS MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-310-6033
Mailing Address - Street 1:24594 SUNNYMEAD BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3730
Mailing Address - Country:US
Mailing Address - Phone:800-310-6033
Mailing Address - Fax:909-599-2181
Practice Address - Street 1:24594 SUNNYMEAD BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:800-310-6033
Practice Address - Fax:909-599-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96536332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96536OtherHMDR LICENSE #