Provider Demographics
NPI:1346325370
Name:EDWARD MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:EDWARD MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-242-9798
Mailing Address - Street 1:23639 SUNNYMEAD BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7703
Mailing Address - Country:US
Mailing Address - Phone:951-242-9798
Mailing Address - Fax:951-242-9796
Practice Address - Street 1:23639 SUNNYMEAD BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7703
Practice Address - Country:US
Practice Address - Phone:951-242-9798
Practice Address - Fax:951-242-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44097332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5584100001Medicare NSC