Provider Demographics
NPI:1285855619
Name:EASY ACCESS MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:EASY ACCESS MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEAGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-861-6308
Mailing Address - Street 1:12555 LAKEWOOD BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2771
Mailing Address - Country:US
Mailing Address - Phone:562-861-6308
Mailing Address - Fax:562-861-6357
Practice Address - Street 1:12555 LAKEWOOD BLVD STE B
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2771
Practice Address - Country:US
Practice Address - Phone:562-861-6308
Practice Address - Fax:562-861-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6007600001Medicare NSC