Provider Demographics
NPI:1942507249
Name:212 MEDICAL SUPPLY
Entity Type:Organization
Organization Name:212 MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-974-6464
Mailing Address - Street 1:3651 LINDELL RD STE D275
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1254
Mailing Address - Country:US
Mailing Address - Phone:702-932-9967
Mailing Address - Fax:
Practice Address - Street 1:3651 LINDELL RD STE D275
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1254
Practice Address - Country:US
Practice Address - Phone:702-932-9967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies