Provider Demographics
NPI:1295864544
Name:ECHOLINE MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ECHOLINE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VISMANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-920-0991
Mailing Address - Street 1:2908 OREGON CT
Mailing Address - Street 2:STE I-12
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2643
Mailing Address - Country:US
Mailing Address - Phone:310-320-1165
Mailing Address - Fax:310-356-3296
Practice Address - Street 1:2908 OREGON CT
Practice Address - Street 2:STE I-12
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2643
Practice Address - Country:US
Practice Address - Phone:310-320-1165
Practice Address - Fax:310-356-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47766332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6113010001Medicare NSC