Provider Demographics
NPI:1336319896
Name:QUALITY MEDICAL SUPPLY CORPORATION
Entity Type:Organization
Organization Name:QUALITY MEDICAL SUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:ECHAUZ
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN,
Authorized Official - Phone:808-677-1000
Mailing Address - Street 1:94-366 PUPUPANI ST
Mailing Address - Street 2:SUITE 209A
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2650
Mailing Address - Country:US
Mailing Address - Phone:808-842-7634
Mailing Address - Fax:808-842-7640
Practice Address - Street 1:94-366 PUPUPANI ST
Practice Address - Street 2:SUITE 209A
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2650
Practice Address - Country:US
Practice Address - Phone:808-842-7634
Practice Address - Fax:808-842-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20540954-01251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI6172040001Medicare NSC