Provider Demographics
NPI:1306090865
Name:SMITTY MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SMITTY MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-677-7911
Mailing Address - Street 1:10719 S INGLEWOOD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-4810
Mailing Address - Country:US
Mailing Address - Phone:310-677-7911
Mailing Address - Fax:310-677-7668
Practice Address - Street 1:10719 S INGLEWOOD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-4810
Practice Address - Country:US
Practice Address - Phone:310-677-7911
Practice Address - Fax:310-667-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6342620001Medicare NSC