Provider Demographics
NPI:1457402497
Name:BROADWAY MEDICAL SERVICE & SUPPLY, INC
Entity Type:Organization
Organization Name:BROADWAY MEDICAL SERVICE & SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIASCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-442-3719
Mailing Address - Street 1:1034 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0126
Mailing Address - Country:US
Mailing Address - Phone:707-442-3719
Mailing Address - Fax:707-442-0237
Practice Address - Street 1:1034 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0126
Practice Address - Country:US
Practice Address - Phone:707-442-3719
Practice Address - Fax:707-442-0237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARR-B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BX2000X332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457402497Medicaid
CA0394420001Medicare NSC