Provider Demographics
NPI:1225391170
Name:EXPRESS MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:EXPRESS MEDICAL SUPPLY, LLC
Other - Org Name:EXPRESS MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:JOCSON
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-423-2600
Mailing Address - Street 1:639 MARSAT CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4678
Mailing Address - Country:US
Mailing Address - Phone:619-423-2600
Mailing Address - Fax:619-423-2681
Practice Address - Street 1:639 MARSAT CT
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4678
Practice Address - Country:US
Practice Address - Phone:619-423-2600
Practice Address - Fax:619-423-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58042332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies