Provision Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROVISION MEDICAL SUPPLY

Practice address

777 W 19TH St Ste F
Costa Mesa, CA 92627-6131

Phone

(949) 662-3933

NPI assigned

Dec 19, 2018

Organization subpart

No

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

Authorized official

Name

Patrick Parke

Title

Ceo

Phone

(949) 662-3933

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1770055477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 W 19TH ST STE F",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926276131",
            "telephone_number": "949-662-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 W 19TH ST STE F",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926276131",
            "telephone_number": "949-662-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "PARKE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-662-3933"
    },
    "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 Costa Mesa, CA
• Providers in Costa Mesa, 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 Jun 9, 2021; 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.