Provider Demographics
NPI:1790919132
Name:BAY AREA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:BAY AREA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-219-0300
Mailing Address - Street 1:14023 CRENSHAW BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-9255
Mailing Address - Country:US
Mailing Address - Phone:310-219-0300
Mailing Address - Fax:310-219-0318
Practice Address - Street 1:14023 CRENSHAW BLVD STE 5
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-9255
Practice Address - Country:US
Practice Address - Phone:310-219-0300
Practice Address - Fax:310-219-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies