Provider Demographics
NPI:1285864207
Name:ASAP MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ASAP MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVOROTSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-596-2727
Mailing Address - Street 1:8790 CUYAMACA ST
Mailing Address - Street 2:STE.B
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4295
Mailing Address - Country:US
Mailing Address - Phone:619-596-2727
Mailing Address - Fax:619-596-2725
Practice Address - Street 1:8790 CUYAMACA ST
Practice Address - Street 2:STE.B
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4295
Practice Address - Country:US
Practice Address - Phone:619-596-2727
Practice Address - Fax:619-596-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48441332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5559340001Medicare NSC