Provider Demographics
NPI:1174390231
Name:LANDSTAR MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:LANDSTAR MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIMOHD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-789-9401
Mailing Address - Street 1:530 BEDFORD RD STE 112
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6554
Mailing Address - Country:US
Mailing Address - Phone:404-789-9401
Mailing Address - Fax:
Practice Address - Street 1:530 BEDFORD RD STE 112
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6554
Practice Address - Country:US
Practice Address - Phone:404-789-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2025-08-09
Deactivation Date:2025-06-20
Deactivation Code:
Reactivation Date:2025-08-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies