Provider Demographics
NPI:1710081930
Name:ITC MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:ITC MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-387-7100
Mailing Address - Street 1:4373 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3003
Mailing Address - Country:US
Mailing Address - Phone:415-387-7100
Mailing Address - Fax:415-387-2540
Practice Address - Street 1:4373 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3003
Practice Address - Country:US
Practice Address - Phone:415-387-7100
Practice Address - Fax:415-387-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ35120ZOtherBLUE SHIELD OF CA
CADME02141FMedicaid
CA0431440002Medicare ID - Type Unspecified