Provider Demographics
NPI:1588860720
Name:DW MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:DW MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WORKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-330-0162
Mailing Address - Street 1:1524 CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1144
Mailing Address - Country:US
Mailing Address - Phone:310-330-0162
Mailing Address - Fax:323-292-0227
Practice Address - Street 1:1524 CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-1144
Practice Address - Country:US
Practice Address - Phone:310-330-0162
Practice Address - Fax:323-292-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47555332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5943840001Medicare NSC