Organization
HAVASU MEDICAL SUPPLY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM JAY GOLDMAN CRT (OWNER RT)
(928) 854-1868
Entity
Organization
Contact information
Practice address
1849 ACOMA BLVD W STE 116, LAKE HAVASU CITY, AZ 86403-3184
(928) 854-1868
(928) 854-1865
Mailing address
1849 ACOMA BLVD W STE 116, LAKE HAVASU CITY, AZ 86403-3184
(928) 854-1868
(928) 854-1865
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
AZ
Other
Enumeration date
04/20/2006
Last updated
10/10/2008
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