Provider Demographics
NPI:1205923679
Name:MEDI-STOP HOME MEDICAL SUPPLIER
Entity type:Organization
Organization Name:MEDI-STOP HOME MEDICAL SUPPLIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-328-9920
Mailing Address - Street 1:PO BOX 40547
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93384-0547
Mailing Address - Country:US
Mailing Address - Phone:661-328-9920
Mailing Address - Fax:661-328-0375
Practice Address - Street 1:815 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2211
Practice Address - Country:US
Practice Address - Phone:661-328-9920
Practice Address - Fax:661-328-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9674128Medicaid
CA0897650001Medicare ID - Type Unspecified