Provider Demographics
NPI:1780022285
Name:ELEGANT MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ELEGANT MEDICAL SUPPLY INC
Other - Org Name:PRECISION REPAIR NEWTORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIBEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:8586999463
Authorized Official - Phone:858-699-9463
Mailing Address - Street 1:14309 TOEPPERWEIN RD STE 406
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3851
Mailing Address - Country:US
Mailing Address - Phone:858-699-9463
Mailing Address - Fax:
Practice Address - Street 1:14309 TOEPPERWEIN RD STE 406
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-3851
Practice Address - Country:US
Practice Address - Phone:858-699-9463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6640830001Medicare NSC