Provider Demographics
NPI:1326059080
Name:BISCHOFF'S MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:BISCHOFF'S MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-338-6552
Mailing Address - Street 1:19100 BIG BASIN WAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-8570
Mailing Address - Country:US
Mailing Address - Phone:831-338-6552
Mailing Address - Fax:831-338-7777
Practice Address - Street 1:1635 DIVISADERO ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3000
Practice Address - Country:US
Practice Address - Phone:415-921-0440
Practice Address - Fax:415-921-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4416050001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4416050001Medicare NSC