Healthcare Provider Details

I. General information

NPI: 1831421742
Provider Name (Legal Business Name): FOLSOM MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E BIDWELL ST
FOLSOM CA
95630-3117
US

IV. Provider business mailing address

422 E BIDWELL ST
FOLSOM CA
95630-3117
US

V. Phone/Fax

Practice location:
  • Phone: 916-293-8897
  • Fax: 916-358-7886
Mailing address:
  • Phone: 916-293-8897
  • Fax: 916-358-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GOPAL K BALAGA
Title or Position: PRESIDENT
Credential:
Phone: 916-524-1533