Provider Demographics
NPI:1659396588
Name:MADDISON MEDICAL DISTRIBUTORS INC
Entity Type:Organization
Organization Name:MADDISON MEDICAL DISTRIBUTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-978-8304
Mailing Address - Street 1:4283 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4545
Mailing Address - Country:US
Mailing Address - Phone:310-978-8304
Mailing Address - Fax:310-978-8394
Practice Address - Street 1:4283 W BROADWAY
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4545
Practice Address - Country:US
Practice Address - Phone:310-978-8304
Practice Address - Fax:310-978-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5743400001Medicare NSC