Provider Demographics
NPI:1053944827
Name:ABIGAIL'S MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ABIGAIL'S MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-940-1132
Mailing Address - Street 1:2020 CAMINO DEL RIO N STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1542
Mailing Address - Country:US
Mailing Address - Phone:760-940-1132
Mailing Address - Fax:760-940-1134
Practice Address - Street 1:2020 CAMINO DEL RIO N STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1542
Practice Address - Country:US
Practice Address - Phone:760-940-1132
Practice Address - Fax:760-940-1134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABIGAIL'S MEDICAL SUPPLIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty