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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 6720840001 | Medicare NSC |