Provider Demographics
NPI:1497783492
Name:BANKY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:BANKY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-645-5877
Mailing Address - Street 1:6824 LA TIJERA BLVD
Mailing Address - Street 2:UNIT #3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1924
Mailing Address - Country:US
Mailing Address - Phone:310-645-5877
Mailing Address - Fax:310-338-0057
Practice Address - Street 1:6824 LA TIJERA BLVD
Practice Address - Street 2:UNIT #3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1924
Practice Address - Country:US
Practice Address - Phone:310-645-5877
Practice Address - Fax:310-338-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103110332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5577410001Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA5577410001Medicare NSC