=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568570794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL SUPPLY SUPERSTORE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 03/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32245 MISSION TRAIL RD D10
-----------------------------------------------------
City | LAKE ELSINORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92530-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-245-2235
-----------------------------------------------------
Fax | 951-245-6405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32245 MISSION TRAIL RD D10
-----------------------------------------------------
City | LAKE ELSINORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92530-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-245-2235
-----------------------------------------------------
Fax | 951-245-6405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOWAFFAQ SAADAT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-245-2235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------