Provider Demographics
NPI:1407330590
Name:SHIELD MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:SHIELD MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-901-8357
Mailing Address - Street 1:PO BOX 211241
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-1241
Mailing Address - Country:US
Mailing Address - Phone:800-901-8357
Mailing Address - Fax:800-901-8357
Practice Address - Street 1:9286 OLD CASTLE RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-5506
Practice Address - Country:US
Practice Address - Phone:800-901-8357
Practice Address - Fax:800-901-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies