Provider Demographics
NPI:1245414515
Name:EL MONTE MEDICAL SUPPLY LLC.
Entity Type:Organization
Organization Name:EL MONTE MEDICAL SUPPLY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTEM
Authorized Official - Middle Name:ANATOLYEVICH
Authorized Official - Last Name:FADEEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-579-2500
Mailing Address - Street 1:9663 GARVEY AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1096
Mailing Address - Country:US
Mailing Address - Phone:626-579-2500
Mailing Address - Fax:626-579-2555
Practice Address - Street 1:9663 GARVEY AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1096
Practice Address - Country:US
Practice Address - Phone:626-579-2500
Practice Address - Fax:626-579-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28935332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6525590001Medicare PIN