Provider Demographics
NPI:1760562698
Name:PALM SPRINGS MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:PALM SPRINGS MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAZANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-327-6230
Mailing Address - Street 1:2500 N PALM CANYON DR
Mailing Address - Street 2:UNIT A-11
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1868
Mailing Address - Country:US
Mailing Address - Phone:760-327-6230
Mailing Address - Fax:760-327-6235
Practice Address - Street 1:2500 N PALM CANYON DR
Practice Address - Street 2:UNIT A-11
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1868
Practice Address - Country:US
Practice Address - Phone:760-327-6230
Practice Address - Fax:760-327-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5891160001Medicare NSC