Provider Demographics
NPI:1508531377
Name:INTERSTATE MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:INTERSTATE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAIG
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:949-386-4054
Mailing Address - Street 1:PO BOX 3342
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-0342
Mailing Address - Country:US
Mailing Address - Phone:949-386-4054
Mailing Address - Fax:800-886-7086
Practice Address - Street 1:1096 N WESTERN AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2340
Practice Address - Country:US
Practice Address - Phone:949-386-4054
Practice Address - Fax:800-886-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies