Provider Demographics
NPI:1356510846
Name:AM MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:AM MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAZMIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-2200
Mailing Address - Street 1:1616 VICTORY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2947
Mailing Address - Country:US
Mailing Address - Phone:818-242-3355
Mailing Address - Fax:818-242-3353
Practice Address - Street 1:1616 VICTORY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2947
Practice Address - Country:US
Practice Address - Phone:818-242-3355
Practice Address - Fax:818-242-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20080112332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6119160001Medicare NSC