Provider Demographics
NPI:1710305461
Name:3RD ST MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:3RD ST MEDICAL SUPPLY, INC.
Other - Org Name:DYNAMIC REPAIR NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABDELLATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-988-6585
Mailing Address - Street 1:1261 S LYON ST
Mailing Address - Street 2:SUITE 05
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4500
Mailing Address - Country:US
Mailing Address - Phone:714-988-6585
Mailing Address - Fax:
Practice Address - Street 1:1261 S LYON ST
Practice Address - Street 2:SUITE 05
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4500
Practice Address - Country:US
Practice Address - Phone:714-988-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6713910004Medicare NSC