Provider Demographics
NPI:1861465734
Name:EWEZCO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EWEZCO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:OGBU
Authorized Official - Last Name:OKPAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:323-702-2264
Mailing Address - Street 1:520 E CARSON PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3220
Mailing Address - Country:US
Mailing Address - Phone:310-965-0230
Mailing Address - Fax:310-965-0263
Practice Address - Street 1:520 E CARSON PLAZA CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3289
Practice Address - Country:US
Practice Address - Phone:310-965-0230
Practice Address - Fax:310-965-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4706270001Medicare NSC