Provider Demographics
NPI:1063696284
Name:MERCED MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:MERCED MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIERA
Authorized Official - Suffix:
Authorized Official - Credentials:RT RCP
Authorized Official - Phone:209-312-1729
Mailing Address - Street 1:1827 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4812
Mailing Address - Country:US
Mailing Address - Phone:209-722-3832
Mailing Address - Fax:209-722-2779
Practice Address - Street 1:1827 CANAL ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4812
Practice Address - Country:US
Practice Address - Phone:209-722-3832
Practice Address - Fax:209-722-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47559332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6409660001Medicare NSC