MEDICARE: ULTIMATE MEDICAL SUPPLY INC.

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	47197	CA

General Provider Information

NPI Number	:	1396940359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	2975 WILSHIRE BLVD
Second Line	:	SUITE Q
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1107
Country	:	US
Telephone Number	:	213-351-9500
Fax Number	:	213-351-9595

Provider Business Practice Location Address
First Line	:	2975 WILSHIRE BLVD
Second Line	:	SUITE Q
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1107
Country	:	US
Telephone Number	:	213-351-9500
Fax Number	:	213-351-9595

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	LAZARE DE CARNOT TAMPA
Credential	:
Telephone Number	:	213-351-9500

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	11/29/2007

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