Provider Demographics
NPI:1811109846
Name:BHB MEDICAL DISTRIBUTORS INC
Entity type:Organization
Organization Name:BHB MEDICAL DISTRIBUTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-594-3818
Mailing Address - Street 1:3960 VALLEY BLVD
Mailing Address - Street 2:STE M
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1528
Mailing Address - Country:US
Mailing Address - Phone:909-594-3818
Mailing Address - Fax:909-594-3106
Practice Address - Street 1:3960 VALLEY BLVD
Practice Address - Street 2:STE M
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1528
Practice Address - Country:US
Practice Address - Phone:909-594-3818
Practice Address - Fax:909-594-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100-067416332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4543650001Medicare ID - Type Unspecified