Provider Demographics
NPI:1265477871
Name:VERMONT MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:VERMONT MEDICAL SUPPLY, INC
Other - Org Name:MASH MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOK
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-487-5695
Mailing Address - Street 1:2681 W OLYMPIC BLVD
Mailing Address - Street 2:101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2883
Mailing Address - Country:US
Mailing Address - Phone:213-487-5695
Mailing Address - Fax:213-487-0203
Practice Address - Street 1:2681 W OLYMPIC BLVD
Practice Address - Street 2:101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2883
Practice Address - Country:US
Practice Address - Phone:213-487-5695
Practice Address - Fax:213-487-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5735120001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5735120001Medicare NSC