Provider Demographics
NPI:1497704548
Name:HEALTH-O-MED, INC.
Entity Type:Organization
Organization Name:HEALTH-O-MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGIY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-654-6890
Mailing Address - Street 1:7606 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6409
Mailing Address - Country:US
Mailing Address - Phone:323-654-6890
Mailing Address - Fax:323-654-8041
Practice Address - Street 1:7606 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6409
Practice Address - Country:US
Practice Address - Phone:323-654-6890
Practice Address - Fax:323-654-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100943332B00000X
CA17276332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02089GMedicaid
CAZZZ44489ZOtherBLUE SHIELD OF CA
CADME02089GMedicaid
CA=========OtherPPO PLANS
CADME02089GMedicaid