# PROVISION MEDICAL SUPPLY

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

## Provider details

- **NPI number:** 1770055477
- **Authorized official:** PATRICK PARKE (CEO)
- **Authorized official phone:** (949) 662-3933

## Contact information

- **Practice address:** 777 W 19TH ST STE F, COSTA MESA, CA 92627-6131
- **Practice address phone:** (949) 662-3933
- **Mailing address:** 777 W 19TH ST STE F, COSTA MESA, CA 92627-6131
- **Mailing address phone:** (949) 662-3933

## Taxonomy

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

## Other

- **Enumeration date:** 12/19/2018
- **Last updated:** 06/09/2021