Healthcare Provider Details

I. General information

NPI: 1689785008
Provider Name (Legal Business Name): ASSURED MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23541 RIDGE ROUTE DR STE A
LAGUNA HILLS CA
92653-1500
US

IV. Provider business mailing address

23541 RIDGE ROUTE DR STE A
LAGUNA HILLS CA
92653-1500
US

V. Phone/Fax

Practice location:
  • Phone: 949-487-0084
  • Fax: 949-487-0083
Mailing address:
  • Phone: 949-487-0084
  • Fax: 949-487-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number101688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number101688
License Number StateCA

VIII. Authorized Official

Name: DENNIS WILLIAM KARNES
Title or Position: CEO
Credential:
Phone: 494-870-0849