MEDICARE: PALM SPRINGS MEDICAL SUPPLIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1760562698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM SPRINGS MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	2500 N PALM CANYON DR
Second Line	:	UNIT A-11
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-1868
Country	:	US
Telephone Number	:	760-327-6230
Fax Number	:	760-327-6235

Provider Business Practice Location Address
First Line	:	2500 N PALM CANYON DR
Second Line	:	UNIT A-11
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-1868
Country	:	US
Telephone Number	:	760-327-6230
Fax Number	:	760-327-6235

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	EVGENY SAZANOV
Credential	:
Telephone Number	:	760-327-6230

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	10/14/2008

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