Provider Demographics
NPI:1831421742
Name:FOLSOM MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:FOLSOM MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-524-1533
Mailing Address - Street 1:422 E BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3117
Mailing Address - Country:US
Mailing Address - Phone:916-293-8897
Mailing Address - Fax:916-358-7886
Practice Address - Street 1:422 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3117
Practice Address - Country:US
Practice Address - Phone:916-293-8897
Practice Address - Fax:916-358-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332H00000XSuppliersEyewear Supplier
No335E00000XSuppliersProsthetic/Orthotic Supplier