Provider Demographics
NPI:1295908085
Name:SHUBBY MEDICAL DISTRIBUTORS INC.
Entity type:Organization
Organization Name:SHUBBY MEDICAL DISTRIBUTORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIBUIKE
Authorized Official - Middle Name:KINGLE
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-675-1023
Mailing Address - Street 1:4240 W EL SEGUNDO BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4542
Mailing Address - Country:US
Mailing Address - Phone:310-675-1023
Mailing Address - Fax:310-675-1509
Practice Address - Street 1:4240 W EL SEGUNDO BLVD # 100
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4542
Practice Address - Country:US
Practice Address - Phone:310-675-1023
Practice Address - Fax:310-675-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49862332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6183420001Medicare NSC