Provider Demographics
NPI:1649383431
Name:OGS MEDICAL & SURGICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:OGS MEDICAL & SURGICAL SUPPLY, INC.
Other - Org Name:TRINITY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-265-0400
Mailing Address - Street 1:6445 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5808
Mailing Address - Country:US
Mailing Address - Phone:619-265-0400
Mailing Address - Fax:619-265-0440
Practice Address - Street 1:6445 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5808
Practice Address - Country:US
Practice Address - Phone:619-265-0400
Practice Address - Fax:619-265-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103670332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02626FMedicaid
1216020001Medicare NSC