Provider Demographics
NPI:1639108798
Name:RON ANDREWS MEDICAL CO
Entity Type:Organization
Organization Name:RON ANDREWS MEDICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-492-1770
Mailing Address - Street 1:117 CARLOS DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2005
Mailing Address - Country:US
Mailing Address - Phone:415-492-1770
Mailing Address - Fax:415-492-0781
Practice Address - Street 1:117 CARLOS DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2005
Practice Address - Country:US
Practice Address - Phone:415-492-1770
Practice Address - Fax:415-492-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100027332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ73979ZMedicaid
CA0622820001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
CAZZZ73979ZMedicaid