Citrus Plaza Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0000012568 Issued in CA

Legal business name

CITRUS PLAZA MEDICAL SUPPLY

Practice address

7433 Greenback LN Ste H
Citrus Heights, CA 95610-5696

Phone

(916) 765-9963

NPI assigned

May 8, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Vladimir Tkach

Title

President

Phone

(916) 765-9963

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1962679985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7433 GREENBACK LN STE H",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956105696",
            "telephone_number": "916-765-9963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7433 GREENBACK LN STE H",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956105696",
            "telephone_number": "916-765-9963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS PLAZA MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "TKACH",
        "authorized_official_first_name": "VLADIMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-765-9963",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "0000012568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citrus Crest Care Home 2 LLC
• Citrus Crest Care Home1
• Citrus Heights Community Healthcare, LLC
• Citrus Heights Dental
• Citrus Heights Terrace
• Payton Morgan Clark Smith
• Angelia Clark
• Chane Clark
• Cierra Clark
• Grace Marie Claydon

• Durable Medical Equipment & Medical Supplies in Citrus Heights, CA
• Providers in Citrus Heights, 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 8, 2008; 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.