Grassroots Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GRASSROOTS MEDICAL SUPPLY

Practice address

Nec Navajo Route 15 and 60
Suite #2
Winlsow, AZ 86047

Phone

(928) 421-5201

NPI assigned

Sep 8, 2017

Last updated

Sep 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brandon Michael Lester

Title

Owner

Phone

(928) 421-5201

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1750809836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 N. HIGHWAY 77",
            "address_2": "PMB 5105",
            "city": "HOLBROOK",
            "state": "AZ",
            "postal_code": "86025",
            "telephone_number": "928-421-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NEC NAVAJO ROUTE 15 AND 60",
            "address_2": "SUITE #2",
            "city": "WINLSOW",
            "state": "AZ",
            "postal_code": "86047",
            "telephone_number": "928-421-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRASSROOTS MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-421-5201"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2017; 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.