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General NPI Number Information
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NPI Number | 1710164595
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S DME INC.
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 305 E HILLCREST BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90301-2405
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Country | US
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Telephone | 310-672-6657
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Fax | 310-671-2870
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Provider Business Mailing Address
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Address Line | 305 E HILLCREST BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90301-2405
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Country | US
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Telephone | 310-672-6657
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Fax | 310-671-2870
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN BASSEY IKPEME
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Credential |
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Telephone | 310-672-6657
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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 | 103708
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License Number State | CA
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