Healthcare Provider Details

I. General information

NPI: 1457402497
Provider Name (Legal Business Name): BROADWAY MEDICAL SERVICE & SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 BROADWAY ST
EUREKA CA
95501-0126
US

IV. Provider business mailing address

1034 BROADWAY ST
EUREKA CA
95501-0126
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-3719
  • Fax: 707-442-0237
Mailing address:
  • Phone: 707-442-3719
  • Fax: 707-442-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number332BX2000X
License Number StateCA

VIII. Authorized Official

Name: MR. RONALD A BIASCA
Title or Position: PRESIDENT
Credential:
Phone: 707-442-3719