Provider Demographics
NPI:1386675288
Name:ESSENTIAL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ESSENTIAL MEDICAL SUPPLY INC
Other - Org Name:ESSENTIAL MEDICAL SUPPLY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-964-9722
Mailing Address - Street 1:1283 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1627
Mailing Address - Country:US
Mailing Address - Phone:323-964-9722
Mailing Address - Fax:323-964-9726
Practice Address - Street 1:1283 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1627
Practice Address - Country:US
Practice Address - Phone:323-964-9722
Practice Address - Fax:323-964-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000034970-0001-6332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5591850001Medicare NSC