Waterman Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

51274 Issued in CA

Legal business name

WATERMAN MEDICAL SUPPLY INC

Practice address

1364 N Waterman Ave
# 105
San Bernardino, CA 92404-5313

Phone

(909) 383-7284

Fax

(909) 383-5433

NPI assigned

Apr 28, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Sergey Ivanov

Title

Ceo

Phone

(909) 383-7284

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242864000000",
    "number": "1205070729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1364 N WATERMAN AVE",
            "address_2": "# 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045313",
            "telephone_number": "909-383-7284",
            "fax_number": "909-383-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 N WATERMAN AVE",
            "address_2": "# 105",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045313",
            "telephone_number": "909-383-7284",
            "fax_number": "909-383-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMAN MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-28",
        "last_updated": "2009-05-21",
        "status": "A",
        "authorized_official_last_name": "IVANOV",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-383-7284",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "51274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronnie Washington
• Taylor Washington
• Washingtons Helping Hand LLC
• Waterman Convalescent Hospital, LLC
• Waterman Health Inc
• Watermanidence Opco, LLC
• Mary Waters Parks, MSG
• Deon Watkins
• Robert William Watrous, MD
• Abigail Christine Watson, B.S.

• Durable Medical Equipment & Medical Supplies in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; 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.