Provider Demographics
NPI:1528575743
Name:OLBO INC
Entity Type:Organization
Organization Name:OLBO INC
Other - Org Name:TBS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEMOER
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:786-708-1646
Mailing Address - Street 1:2515 CAMINO DEL RIO S STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3714
Mailing Address - Country:US
Mailing Address - Phone:888-464-9015
Mailing Address - Fax:
Practice Address - Street 1:2515 CAMINO DEL RIO S STE 113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3714
Practice Address - Country:US
Practice Address - Phone:888-464-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLBO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113310OtherCALIFORNIA HME LICENSE