Provider Demographics
NPI:1225892995
Name:MEDISUPPLIES, INC.
Entity Type:Organization
Organization Name:MEDISUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-310-5053
Mailing Address - Street 1:7927 GARDEN GROVE BLVD # 400
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4225
Mailing Address - Country:US
Mailing Address - Phone:562-310-5053
Mailing Address - Fax:
Practice Address - Street 1:1830 S SANTA FE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4823
Practice Address - Country:US
Practice Address - Phone:562-310-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier