Provider Demographics
NPI:1841200359
Name:MED SYSTEMS, INC.
Entity Type:Organization
Organization Name:MED SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DONN
Authorized Official - Last Name:ZORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-287-2450
Mailing Address - Street 1:825 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2115
Mailing Address - Country:US
Mailing Address - Phone:505-287-2450
Mailing Address - Fax:505-287-2497
Practice Address - Street 1:825 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2115
Practice Address - Country:US
Practice Address - Phone:505-287-2450
Practice Address - Fax:505-287-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01138484000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00T21POtherBC/BS OF NM
NMK4985Medicaid
NM1100770001Medicare ID - Type Unspecified