Provider Demographics
NPI:1356485361
Name:DOC'S MEDICAL MART
Entity Type:Organization
Organization Name:DOC'S MEDICAL MART
Other - Org Name:BISCHOFF'S MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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 1:4670 CENTRAL WAY STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1806
Practice Address - Country:US
Practice Address - Phone:707-864-6680
Practice Address - Fax:707-864-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5631990002Medicare ID - Type Unspecified
CA4416050001Medicare ID - Type UnspecifiedBISCHOFF'S MEDICAL
CA4416050002Medicare ID - Type UnspecifiedBISCHOFF'S MEDICAL
CA5631990003Medicare ID - Type Unspecified