MEDICARE: MEDSUPPLY

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	332BX2000X	Oxygen Equipment & Supplies (DME)	43583	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43583	OTHER	CA	CA HOME MEDICAL DEVICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619021292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSUPPLY

Provider Business Mailing Address
First Line	:	5105 E DAKOTA AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7443
Country	:	US
Telephone Number	:	559-292-1540
Fax Number	:	559-292-1539

Provider Business Practice Location Address
First Line	:	5105 E DAKOTA AVE STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7443
Country	:	US
Telephone Number	:	559-292-1540
Fax Number	:	559-292-1539

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ADAM J FRERICHS
Credential	:
Telephone Number	:	559-292-1540

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/22/2020

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Directions to “MEDSUPPLY ” Practice Location

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