=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124136619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL MEDICAL SUPPLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2006
-----------------------------------------------------
Last Update Date | 08/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 937 S LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-674-5800
-----------------------------------------------------
Fax | 310-674-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 937 S LA BREA AVE
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-674-5800
-----------------------------------------------------
Fax | 310-674-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. ONWUDIWE C NYENKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-674-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 103151
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------