Provider Demographics
NPI:1124136619
Name:CENTRAL MEDICAL SUPPLY
Entity type:Organization
Organization Name:CENTRAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ONWUDIWE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NYENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-674-5800
Mailing Address - Street 1:937 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3815
Mailing Address - Country:US
Mailing Address - Phone:310-674-5800
Mailing Address - Fax:310-674-5900
Practice Address - Street 1:937 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3815
Practice Address - Country:US
Practice Address - Phone:310-674-5800
Practice Address - Fax:310-674-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103151332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4912310001Medicare NSC