Provider Demographics
NPI:1316188683
Name:EDGEMONT MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:EDGEMONT MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EPREM
Authorized Official - Middle Name:
Authorized Official - Last Name:FODOLYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-665-4288
Mailing Address - Street 1:1041 N EDGEMONT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2533
Mailing Address - Country:US
Mailing Address - Phone:323-665-4288
Mailing Address - Fax:323-665-7729
Practice Address - Street 1:1041 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2533
Practice Address - Country:US
Practice Address - Phone:323-665-4288
Practice Address - Fax:323-665-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000241471900017332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6439380001Medicare NSC