Provider Demographics
NPI:1164447090
Name:EMG MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:EMG MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLAWALE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SALAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-375-9677
Mailing Address - Street 1:22750 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3667
Mailing Address - Country:US
Mailing Address - Phone:310-375-9677
Mailing Address - Fax:310-375-5615
Practice Address - Street 1:22750 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3667
Practice Address - Country:US
Practice Address - Phone:310-375-9677
Practice Address - Fax:310-375-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103257332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5097910001Medicare ID - Type UnspecifiedPROVIDER NUMBER