Provider Demographics
NPI:1649203894
Name:CARAVAN MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CARAVAN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EHIGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-215-3641
Mailing Address - Street 1:6167 BRISTOL PKWY STE 335
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6666
Mailing Address - Country:US
Mailing Address - Phone:310-215-3641
Mailing Address - Fax:310-215-1131
Practice Address - Street 1:6167 BRISTOL PKWY STE 335
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6666
Practice Address - Country:US
Practice Address - Phone:310-215-3641
Practice Address - Fax:310-215-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3980110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER