Provider Demographics
NPI:1629259759
Name:BULRUSH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:BULRUSH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-485-7874
Mailing Address - Street 1:6930 VILLAGE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2488
Mailing Address - Country:US
Mailing Address - Phone:888-485-7874
Mailing Address - Fax:866-887-1625
Practice Address - Street 1:1776 LAGUNA ST
Practice Address - Street 2:#308
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2981
Practice Address - Country:US
Practice Address - Phone:925-429-4738
Practice Address - Fax:866-887-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103740332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5217580001Medicare NSC