Provider Demographics
NPI:1689785008
Name:ASSURED MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ASSURED MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:494-870-0849
Mailing Address - Street 1:23541 RIDGE ROUTE DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1500
Mailing Address - Country:US
Mailing Address - Phone:949-487-0084
Mailing Address - Fax:949-487-0083
Practice Address - Street 1:23541 RIDGE ROUTE DR
Practice Address - Street 2:STE A
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1500
Practice Address - Country:US
Practice Address - Phone:949-487-0084
Practice Address - Fax:949-487-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101688332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03191FMedicaid
CADME03191FMedicaid