MEDICARE: EMMANUEL MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396928818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1330 E SOUTH ST STE 5
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4380
Country	:	US
Telephone Number	:	562-422-3999
Fax Number	:	562-422-3988

Provider Business Practice Location Address
First Line	:	1330 E SOUTH ST STE 5
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4380
Country	:	US
Telephone Number	:	562-422-3999
Fax Number	:	562-422-3988

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AKINOLA EMMANUEL AFOLABI
Credential	:
Telephone Number	:	562-422-3999

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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