Healthcare Provider Details

I. General information

NPI: 1619021292
Provider Name (Legal Business Name): MEDSUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 E DAKOTA AVE STE 102
FRESNO CA
93727-7443
US

IV. Provider business mailing address

5105 E DAKOTA AVE STE 102
FRESNO CA
93727-7443
US

V. Phone/Fax

Practice location:
  • Phone: 559-292-1540
  • Fax: 559-292-1539
Mailing address:
  • Phone: 559-292-1540
  • Fax: 559-292-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number43583
License Number StateCA

VIII. Authorized Official

Name: MR. ADAM J FRERICHS
Title or Position: PRESIDENT
Credential:
Phone: 559-292-1540