Provider Demographics
NPI:1629696166
Name:AMERICAN SURGICAL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:AMERICAN SURGICAL MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:LAFAYETTE
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:760-599-8800
Mailing Address - Street 1:6965 EL CAMINO REAL STE 105-253
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4100
Mailing Address - Country:US
Mailing Address - Phone:760-845-7032
Mailing Address - Fax:909-366-5988
Practice Address - Street 1:17581 IRVINE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3123
Practice Address - Country:US
Practice Address - Phone:888-501-7751
Practice Address - Fax:909-366-5908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SURGICAL MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment