NPIMap

Organization Active NPI

Ultra Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Bullhead City, AZ
National Provider Identifier
1184024879
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
21026176 Issued in AZ
Legal business name
ULTRA MEDICAL SUPPLY
Practice address
1331 Baseline Rd
Unit 2
Bullhead City, AZ 86442-6719
Phone
(718) 796-7555
Fax
(516) 566-2395
NPI assigned
Aug 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ezriel Ungar
Title
Controller
Phone
(718) 796-7555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 21026176 AZ Primary

Addresses

Primary practice location

1331 Baseline Rd
Unit 2
Bullhead City, AZ 86442-6719

Mailing address

1331 Baseline Rd
Unit 2
Bullhead City, AZ 86442-6719
Phone (718) 796-7555

Other identifiers 1

IdentifierTypeStateIssuer
898874MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Ultra Medical Supply8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1331 Baseline Rd
Ste 2
Bullhead City, AZ 86442

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410307200000",
    "number": "1184024879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 BASELINE RD",
            "address_2": "UNIT 2",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426719",
            "telephone_number": "718-796-7555",
            "fax_number": "516-566-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 BASELINE RD",
            "address_2": "UNIT 2",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426719",
            "telephone_number": "718-796-7555",
            "fax_number": "516-566-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTRA MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-29",
        "last_updated": "2014-09-10",
        "status": "A",
        "authorized_official_last_name": "UNGAR",
        "authorized_official_first_name": "EZRIEL",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "718-796-7555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "21026176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "898874",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullhead City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.