Provider Demographics
NPI:1396940359
Name:ULTIMATE MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:ULTIMATE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZARE
Authorized Official - Middle Name:DE CARNOT
Authorized Official - Last Name:TAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-351-9500
Mailing Address - Street 1:2975 WILSHIRE BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1107
Mailing Address - Country:US
Mailing Address - Phone:213-351-9500
Mailing Address - Fax:213-351-9595
Practice Address - Street 1:2975 WILSHIRE BLVD
Practice Address - Street 2:SUITE Q
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1107
Practice Address - Country:US
Practice Address - Phone:213-351-9500
Practice Address - Fax:213-351-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47197332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5920180001Medicare NSC