MEDICARE: HARBOR 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
2	332B00000X	Durable Medical Equipment & Medical Supplies	DME0218OF	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720117203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2917 W CAPITOL AVE
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-2910
Country	:	US
Telephone Number	:	916-372-8766
Fax Number	:	916-372-1750

Provider Business Practice Location Address
First Line	:	2917 W CAPITOL AVE
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-2910
Country	:	US
Telephone Number	:	916-372-8766
Fax Number	:	916-372-1750

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. NELLY MERZHERITSKY
Credential	:
Telephone Number	:	415-336-9269

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	10/12/2007

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Directions to “HARBOR MEDICAL SUPPLY ” Practice Location

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