Provider Demographics
NPI:1881835908
Name:SIERRA MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SIERRA MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROTHELL
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:661-250-2510
Mailing Address - Street 1:17812 SIERRA HWY
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1645
Mailing Address - Country:US
Mailing Address - Phone:661-250-2510
Mailing Address - Fax:661-250-2509
Practice Address - Street 1:17812 SIERRA HWY
Practice Address - Street 2:STE C
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-1645
Practice Address - Country:US
Practice Address - Phone:661-250-2510
Practice Address - Fax:661-250-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6326910001Medicare NSC