Provider Demographics
NPI:1013267863
Name:CHARTER MEDICAL SUPPLIES. LLC.
Entity type:Organization
Organization Name:CHARTER MEDICAL SUPPLIES. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-303-9328
Mailing Address - Street 1:2049 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3334
Mailing Address - Country:US
Mailing Address - Phone:818-303-9328
Mailing Address - Fax:818-303-2606
Practice Address - Street 1:2049 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3334
Practice Address - Country:US
Practice Address - Phone:818-303-9328
Practice Address - Fax:818-303-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6720840001Medicare NSC