MEDICARE: MERCY MEDICAL SUPPLIES, 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	103688	CA

General Provider Information

NPI Number	:	1992912406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	1410 W ALONDRA BLVD
Second Line	:	SUITE 6
City	:	COMPTON
State	:	CA
Zip	:	90220-3533
Country	:	US
Telephone Number	:	310-637-6993
Fax Number	:	310-637-2342

Provider Business Practice Location Address
First Line	:	1410 W ALONDRA BLVD
Second Line	:	SUITE 6
City	:	COMPTON
State	:	CA
Zip	:	90220-3533
Country	:	US
Telephone Number	:	310-637-6993
Fax Number	:	310-637-2342

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGEL MICHEL JR.
Credential	:
Telephone Number	:	310-637-6993

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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