Provider Demographics
NPI:1699163741
Name:ALL SEASONS MEDICAL SUPPLY
Entity type:Organization
Organization Name:ALL SEASONS MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TELLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:805-844-8235
Mailing Address - Street 1:1220 E AVENUE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6196
Mailing Address - Country:US
Mailing Address - Phone:877-252-4363
Mailing Address - Fax:
Practice Address - Street 1:1220 E AVENUE S
Practice Address - Street 2:SUITE B
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6196
Practice Address - Country:US
Practice Address - Phone:877-252-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7554670001Medicare NSC