Provider Demographics
NPI:1699760231
Name:CENTRAL VALLEY MEDICAL SUPPORT, INC.
Entity type:Organization
Organization Name:CENTRAL VALLEY MEDICAL SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-823-2337
Mailing Address - Street 1:PO BOX 2564
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-1167
Mailing Address - Country:US
Mailing Address - Phone:209-823-2337
Mailing Address - Fax:
Practice Address - Street 1:1434 DEER CREEK CT
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-9110
Practice Address - Country:US
Practice Address - Phone:209-823-2337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01780GMedicaid
CA0746960001Medicare ID - Type UnspecifiedPROVIDER NUMBER