Medi-Source Equipment & Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

53366 Issued in CA

Legal business name

MEDI-SOURCE EQUIPMENT & SUPPLY INC

Practice address

57725 Twentynine Palms Hwy
Suite 402
Yucca Valley, CA 92284-3046

Phone

(760) 365-6389

Fax

(760) 365-7016

NPI assigned

Jan 19, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Esta E Willman

Title

President

Phone

(760) 365-6389

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274659200000",
    "number": "1821078577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 712",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922860712",
            "telephone_number": "760-365-6389",
            "fax_number": "760-365-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57725 TWENTYNINE PALMS HWY",
            "address_2": "SUITE 402",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922843046",
            "telephone_number": "760-365-6389",
            "fax_number": "760-365-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI-SOURCE EQUIPMENT & SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2010-05-24",
        "status": "A",
        "authorized_official_last_name": "WILLMAN",
        "authorized_official_first_name": "ESTA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-365-6389",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "53366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME02109F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon D McIntosh
• Lucenther Cynthia McKethan
• MDM Pharmacy Services LLC
• MDM Pharmacy Services LLC
• Kathleen Jayo Meads, MFT INTERN
• Medical Specialty Center
• Medical Specialty Center
• Medicine Woman Chiropractic for Women
• Medicus, a Medical Corporation
• Louis James Medina

• Durable Medical Equipment & Medical Supplies in Yucca Valley, CA
• Providers in Yucca Valley, 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 24, 2010; 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.