Eastside Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

EASTSIDE MEDICAL SUPPLY INC

Practice address

2720 E Palmdale Blvd
Suite 124
Palmdale, CA 93550-4930

Phone

(661) 272-0004

NPI assigned

Jun 2, 2011

Organization subpart

No

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

Authorized official

Name

Liana Grigoryan

Title

Ceo

Phone

(661) 272-0004

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324598400000",
    "number": "1689968042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 E PALMDALE BLVD",
            "address_2": "SUITE 124",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935504930",
            "telephone_number": "661-272-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 E PALMDALE BLVD",
            "address_2": "SUITE 124",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935504930",
            "telephone_number": "661-272-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-12-23",
        "status": "A",
        "authorized_official_last_name": "GRIGORYAN",
        "authorized_official_first_name": "LIANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-272-0004"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Palmdale, CA
• Providers in Palmdale, 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 Dec 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.