MEDICARE: PIONEER MEDICAL SUPPLY SERVICE

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	103149	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	:	1740248475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER MEDICAL SUPPLY SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 451155
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-8511
Country	:	US
Telephone Number	:	323-778-3815
Fax Number	:	323-778-3819

Provider Business Practice Location Address
First Line	:	8221 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3036
Country	:	US
Telephone Number	:	323-778-3815
Fax Number	:	323-778-3819

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	BEN AGHA OFFOR
Credential	:
Telephone Number	:	323-778-3815

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	11/13/2007

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Directions to “PIONEER MEDICAL SUPPLY SERVICE ” Practice Location

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