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General NPI Number Information
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NPI Number | 1689682866
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL MEDICAL SUPPLY SERVICES
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7200 BANCROFT AVE SUITE 128
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City | OAKLAND
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State | CA
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Zip | 94605-2403
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Country | US
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Telephone | 510-553-9159
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Fax | 510-553-9256
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Provider Business Mailing Address
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Address Line | 7200 BANCROFT AVE SUITE 128
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City | OAKLAND
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State | CA
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Zip | 94605-2403
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Country | US
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Telephone | 510-553-9159
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Fax | 510-553-9256
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES LEE KELLY SEABORN
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Credential |
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Telephone | 510-553-9159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1232010
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License Number State | CA
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