Provider Demographics
NPI:1437464070
Name:ERICO MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:ERICO MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMOFEEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-520-5823
Mailing Address - Street 1:1706 ERRINGER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6500
Mailing Address - Country:US
Mailing Address - Phone:805-520-5823
Mailing Address - Fax:805-520-5832
Practice Address - Street 1:1706 ERRINGER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6500
Practice Address - Country:US
Practice Address - Phone:805-520-5823
Practice Address - Fax:805-520-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1840301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6450160001Medicare NSC