Provider Demographics
NPI:1881846665
Name:HEALTHLINK MEDICAL SUPPLY & DISTRIBUTORS, INC
Entity Type:Organization
Organization Name:HEALTHLINK MEDICAL SUPPLY & DISTRIBUTORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:CHIDI
Authorized Official - Last Name:UMEH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:310-538-9350
Mailing Address - Street 1:17725 CRENSHAW BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4154
Mailing Address - Country:US
Mailing Address - Phone:310-538-9350
Mailing Address - Fax:
Practice Address - Street 1:17725 CRENSHAW BLVD
Practice Address - Street 2:206
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4138
Practice Address - Country:US
Practice Address - Phone:310-538-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-12
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50334332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6194600001Medicare NSC