Provider Demographics
NPI:1194809871
Name:ABACUS MEDICAL EQUIPMENT SUPPLY, INC.
Entity type:Organization
Organization Name:ABACUS MEDICAL EQUIPMENT SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-965-4352
Mailing Address - Street 1:8510 MADISON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3809
Mailing Address - Country:US
Mailing Address - Phone:916-965-4352
Mailing Address - Fax:916-965-5723
Practice Address - Street 1:8510 MADISON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3809
Practice Address - Country:US
Practice Address - Phone:916-965-4352
Practice Address - Fax:916-965-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315938332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02906FMedicaid
CADME02906FMedicaid