Provider Demographics
NPI:1699005041
Name:SHOES AND MED EQUIPMENT CORPORATION
Entity Type:Organization
Organization Name:SHOES AND MED EQUIPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YEMENEJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-644-8880
Mailing Address - Street 1:5065 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6133
Mailing Address - Country:US
Mailing Address - Phone:323-644-8880
Mailing Address - Fax:323-644-8881
Practice Address - Street 1:5065 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6133
Practice Address - Country:US
Practice Address - Phone:323-644-8880
Practice Address - Fax:323-644-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52724332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6449480001Medicare NSC