Provider Demographics
NPI:1568570794
Name:MEDICAL SUPPLY SUPERSTORE INC
Entity Type:Organization
Organization Name:MEDICAL SUPPLY SUPERSTORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOWAFFAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAADAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-245-2235
Mailing Address - Street 1:32245 MISSION TRAIL RD
Mailing Address - Street 2:D10
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4528
Mailing Address - Country:US
Mailing Address - Phone:951-245-2235
Mailing Address - Fax:951-245-6405
Practice Address - Street 1:32245 MISSION TRAIL RD
Practice Address - Street 2:D10
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4528
Practice Address - Country:US
Practice Address - Phone:951-245-2235
Practice Address - Fax:951-245-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03023FOtherMEDICA
CADME03023FOtherMEDICA
CADME03023FOtherMEDICA