Provider Demographics
NPI:1588864540
Name:EXPRESS MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:EXPRESS MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUSIK
Authorized Official - Middle Name:
Authorized Official - Last Name:APIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-453-6211
Mailing Address - Street 1:2231 MCCULLOCH BLVD N STE 111
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6911
Mailing Address - Country:US
Mailing Address - Phone:928-453-6211
Mailing Address - Fax:928-453-2072
Practice Address - Street 1:2231 MCCULLOCH BLVD N STE 111
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6911
Practice Address - Country:US
Practice Address - Phone:928-453-6211
Practice Address - Fax:928-453-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5965040001Medicare NSC