Provider Demographics
NPI:1821268541
Name:AVH MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:AVH MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDNT
Authorized Official - Prefix:
Authorized Official - First Name:KAKHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSHIASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-842-0501
Mailing Address - Street 1:1113 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2528
Mailing Address - Country:US
Mailing Address - Phone:818-842-0501
Mailing Address - Fax:818-842-0584
Practice Address - Street 1:1113 N HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2528
Practice Address - Country:US
Practice Address - Phone:818-842-0501
Practice Address - Fax:818-842-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000231817600010332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6106890002Medicare NSC