Provider Demographics
NPI:1396432035
Name:MEDSUPPLY
Entity type:Organization
Organization Name:MEDSUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-696-9356
Mailing Address - Street 1:3119 TOMAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3119 TOMAHAWK DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2472
Practice Address - Country:US
Practice Address - Phone:559-292-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies