Organization
LIVE WELL MEDICAL SUPPLIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KIETH SIRKO (PRESIDENT/CEO)
(951) 656-3700
Entity
Organization
Contact information
Practice address
7338 SYCAMORE CANYON BLVD, SUITE 1, RIVERSIDE, CA 92508-2318
(951) 656-3700
(951) 697-5866
Mailing address
7338 SYCAMORE CANYON BLVD, SUITE 1, RIVERSIDE, CA 92508-2318
(951) 656-3700
(951) 697-5866
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
55273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55273
HOME MEDICAL DEVICE RETAILER
CA
Enumeration date
04/12/2012
Last updated
04/12/2012
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