Provider Demographics
NPI:1437477072
Name:S & S MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:S & S MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SELAMAWIT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-417-3643
Mailing Address - Street 1:5250 W CENTURY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5972
Mailing Address - Country:US
Mailing Address - Phone:310-417-3643
Mailing Address - Fax:310-417-3622
Practice Address - Street 1:5250 W CENTURY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5972
Practice Address - Country:US
Practice Address - Phone:310-417-3643
Practice Address - Fax:310-417-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51902332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6457830001Medicare NSC