# CHAMPION MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437336955
- **Authorized official:** MR. JEROME KEVIN TYLER (OWNER)
- **Authorized official phone:** (310) 462-1944

## Contact information

- **Practice address:** 1996 GLENTANA ST, SIMI VALLEY, CA 93065-0553
- **Practice address phone:** (310) 462-1944
- **Practice address fax:** (805) 582-9873
- **Mailing address:** 1996 GLENTANA STREET, SIMI VALLEY, CA 93065
- **Mailing address phone:** (310) 462-1944
- **Mailing address fax:** (805) 582-9873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 01/28/2008
- **Last updated:** 01/28/2008