Provider Demographics
NPI:1992871180
Name:SPEEDYCARE MEDICAL DISTRIBUTORS , INC.
Entity type:Organization
Organization Name:SPEEDYCARE MEDICAL DISTRIBUTORS , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:I
Authorized Official - Last Name:UWAEZUOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-242-2018
Mailing Address - Street 1:8955 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3549
Mailing Address - Country:US
Mailing Address - Phone:323-242-2018
Mailing Address - Fax:323-834-0476
Practice Address - Street 1:8955 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3549
Practice Address - Country:US
Practice Address - Phone:323-242-2018
Practice Address - Fax:323-834-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102327332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26821OtherCARE 1ST HEALTH PLAN
CADME03093FMedicaid
CADME03093FMedicaid