Provider Demographics
NPI:1245385210
Name:MD MEDICAL AND MOBILITY PRODUCTS
Entity Type:Organization
Organization Name:MD MEDICAL AND MOBILITY PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-453-1324
Mailing Address - Street 1:PO BOX 160325
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-0325
Mailing Address - Country:US
Mailing Address - Phone:916-453-1324
Mailing Address - Fax:916-453-0952
Practice Address - Street 1:4749 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-4425
Practice Address - Country:US
Practice Address - Phone:916-453-1324
Practice Address - Fax:916-453-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADME0223G332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02203GMedicaid
CA1307800001Medicare NSC