Provider Demographics
NPI:1184794596
Name:D R MEDICAL SUPPLY
Entity type:Organization
Organization Name:D R MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-857-0613
Mailing Address - Street 1:5552 RANTHOM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3958
Mailing Address - Country:US
Mailing Address - Phone:805-857-0613
Mailing Address - Fax:805-435-0432
Practice Address - Street 1:5552 RANTHOM AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3958
Practice Address - Country:US
Practice Address - Phone:805-857-0613
Practice Address - Fax:805-435-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment