Provider Demographics
NPI:1174543912
Name:XTREME MEDICAL INC
Entity type:Organization
Organization Name:XTREME MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-803-9444
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93243-0068
Mailing Address - Country:US
Mailing Address - Phone:661-248-6260
Mailing Address - Fax:661-248-6270
Practice Address - Street 1:49744 GORMAN POST RD
Practice Address - Street 2:4
Practice Address - City:GORMAN
Practice Address - State:CA
Practice Address - Zip Code:93243-9701
Practice Address - Country:US
Practice Address - Phone:661-248-6260
Practice Address - Fax:661-248-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN796130800Medicaid
SD9167760Medicaid
OH2182070Medicaid
CADME03181FMedicaid
TN4582154Medicaid
NH30760747Medicaid
KY90001231Medicaid
WA9049438Medicaid
IN200854070AMedicaid
WA9049438Medicaid
WA9049438Medicaid