Provider Demographics
NPI:1619021292
Name:MEDSUPPLY
Entity Type:Organization
Organization Name:MEDSUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-292-1540
Mailing Address - Street 1:5105 E DAKOTA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-7443
Mailing Address - Country:US
Mailing Address - Phone:559-292-1540
Mailing Address - Fax:559-292-1539
Practice Address - Street 1:5105 E DAKOTA AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-7443
Practice Address - Country:US
Practice Address - Phone:559-292-1540
Practice Address - Fax:559-292-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43583332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43583OtherCA HOME MEDICAL DEVICE
CADME03428FMedicaid
CADME03428FMedicaid