Provider Demographics
NPI:1306801261
Name:AIR CARE MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:AIR CARE MEDICAL SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LAZER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:818-782-3900
Mailing Address - Street 1:6900 CANBY AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-8730
Mailing Address - Country:US
Mailing Address - Phone:818-782-3900
Mailing Address - Fax:818-782-3992
Practice Address - Street 1:6900 CANBY AVE
Practice Address - Street 2:STE 105
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4312
Practice Address - Country:US
Practice Address - Phone:818-782-3900
Practice Address - Fax:818-782-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100317332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01835GMedicaid
CADME01835GMedicaid