=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194809871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABACUS MEDICAL EQUIPMENT SUPPLY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8510 MADISON AVE SUITE D
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-965-4352
-----------------------------------------------------
Fax | 916-965-5723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8510 MADISON AVE SUITE D
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-965-4352
-----------------------------------------------------
Fax | 916-965-5723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. PATTY J SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-965-4352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 315938
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------