Healthcare Provider Details

I. General information

NPI: 1316982127
Provider Name (Legal Business Name): TRU-CARE MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 S NOVATO BLVD SUITE D
NOVATO CA
94947-4141
US

IV. Provider business mailing address

1559 S NOVATO BLVD SUITE D
NOVATO CA
94947-4141
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-6971
  • Fax: 415-209-6974
Mailing address:
  • Phone: 415-209-6971
  • Fax: 415-209-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number52474
License Number StateCA

VIII. Authorized Official

Name: MR. WILLIAM L. FOURNIER
Title or Position: PRESIDENT
Credential:
Phone: 415-209-6971