Provider Demographics
NPI:1740248475
Name:PIONEER MEDICAL SUPPLY SERVICE
Entity type:Organization
Organization Name:PIONEER MEDICAL SUPPLY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:AGHA
Authorized Official - Last Name:OFFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-778-3815
Mailing Address - Street 1:PO BOX 451155
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8511
Mailing Address - Country:US
Mailing Address - Phone:323-778-3815
Mailing Address - Fax:323-778-3819
Practice Address - Street 1:8221 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3036
Practice Address - Country:US
Practice Address - Phone:323-778-3815
Practice Address - Fax:323-778-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103149332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03188FMedicaid
CADME03188FMedicaid