Provider Demographics
NPI:1750326096
Name:ADELCO MEDICAL DISTRIBUTORS INC
Entity Type:Organization
Organization Name:ADELCO MEDICAL DISTRIBUTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKWEBELEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-856-4701
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251
Mailing Address - Country:US
Mailing Address - Phone:310-856-4701
Mailing Address - Fax:310-856-4705
Practice Address - Street 1:15223 SO .CRENSHAW BLVD # B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4048
Practice Address - Country:US
Practice Address - Phone:310-856-4701
Practice Address - Fax:310-856-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101427332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4517380001Medicare NSC