Provider Demographics
NPI:1619292018
Name:1ST MEDICAL SUPPLY
Entity Type:Organization
Organization Name:1ST MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-737-9397
Mailing Address - Street 1:12639 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4172
Mailing Address - Country:US
Mailing Address - Phone:866-737-9397
Mailing Address - Fax:866-229-1060
Practice Address - Street 1:12639 HOOVER ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4172
Practice Address - Country:US
Practice Address - Phone:866-737-9397
Practice Address - Fax:866-229-1060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-29
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS12302OtherBOC
CA6441050002Medicare NSC