Provider Demographics
NPI:1518990050
Name:BLUESCOPE HEALTH PROFESSIONAL INC
Entity Type:Organization
Organization Name:BLUESCOPE HEALTH PROFESSIONAL INC
Other - Org Name:BLUESCOPE MEDICAL SUPPLIES & DISTRIBUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHILAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-366-1306
Mailing Address - Street 1:18051 CRENSHAW BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5138
Mailing Address - Country:US
Mailing Address - Phone:310-366-1306
Mailing Address - Fax:310-366-7283
Practice Address - Street 1:18051 CRENSHAW BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5138
Practice Address - Country:US
Practice Address - Phone:310-366-1306
Practice Address - Fax:310-366-7283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUESCOPE HEALTH PROFESSIONAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5061640001332B00000X
CA103339332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5061640001Medicare NSC