Provider Demographics
NPI:1962485763
Name:U. ETE MEDICAL DISTRIBUTORS, INC
Entity Type:Organization
Organization Name:U. ETE MEDICAL DISTRIBUTORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UBEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-523-9038
Mailing Address - Street 1:PO BOX 2343
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-0343
Mailing Address - Country:US
Mailing Address - Phone:310-523-9038
Mailing Address - Fax:310-523-5814
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE #119
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-523-9038
Practice Address - Fax:310-523-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102395Medicare ID - Type UnspecifiedFOOD & DRUG LICENSE
CA1245400001Medicare NSC