Healthcare Provider Details

I. General information

NPI: 1326059080
Provider Name (Legal Business Name): BISCHOFF'S MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 DIVISADERO ST STE 105
SAN FRANCISCO CA
94115-3000
US

IV. Provider business mailing address

19100 BIG BASIN WAY
BOULDER CREEK CA
95006-8570
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-0440
  • Fax: 415-921-3221
Mailing address:
  • Phone: 831-338-6552
  • Fax: 831-338-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4416050001
License Number StateCA

VIII. Authorized Official

Name: JOCELYN BISCHOFF
Title or Position: SECRETARY
Credential:
Phone: 831-338-6552