Provider Demographics
NPI:1215377783
Name:SHERMAN OAKS MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:SHERMAN OAKS MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-896-9996
Mailing Address - Street 1:10725 SAN FERNANDO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2628
Mailing Address - Country:US
Mailing Address - Phone:818-896-9996
Mailing Address - Fax:818-896-4851
Practice Address - Street 1:10725 SAN FERNANDO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2628
Practice Address - Country:US
Practice Address - Phone:818-896-9996
Practice Address - Fax:818-896-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59563332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies