Provider Demographics
NPI:1194857102
Name:ACTION A1 MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ACTION A1 MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-419-7821
Mailing Address - Street 1:300 W MANCHESTER BLVD
Mailing Address - Street 2:#104
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1108
Mailing Address - Country:US
Mailing Address - Phone:310-419-7821
Mailing Address - Fax:310-419-4116
Practice Address - Street 1:300 W MANCHESTER BLVD
Practice Address - Street 2:#104
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1108
Practice Address - Country:US
Practice Address - Phone:310-419-7821
Practice Address - Fax:310-419-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6084520001Medicare NSC