Provider Demographics
NPI:1497949630
Name:INLAND SURGICAL SUPPLY CO
Entity Type:Organization
Organization Name:INLAND SURGICAL SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-946-4449
Mailing Address - Street 1:436 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4218
Mailing Address - Country:US
Mailing Address - Phone:909-946-4449
Mailing Address - Fax:909-946-5951
Practice Address - Street 1:436 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4218
Practice Address - Country:US
Practice Address - Phone:909-946-4449
Practice Address - Fax:909-946-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASR EH 100-360603332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70830ZMedicaid
CAZZZ70830ZMedicaid