Healthcare Provider Details

I. General information

NPI: 1093277485
Provider Name (Legal Business Name): AMERICAN SURGICAL MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24735 REDLANDS BLVD STE A
LOMA LINDA CA
92354-4033
US

IV. Provider business mailing address

6965 EL CAMINO REAL # 105-253
CARLSBAD CA
92009-4100
US

V. Phone/Fax

Practice location:
  • Phone: 866-611-7205
  • Fax: 909-366-5988
Mailing address:
  • Phone: 760-599-8800
  • Fax: 760-599-8844

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN LAFAYETTE NEWSOME III
Title or Position: VICE PRESIDNET
Credential: RTS
Phone: 760-599-8800