1730134685 NPI number — SUBURBAN MEDICAL EQUIPMENT & SUPPLIES, INC.

Table of content: (NPI 1730134685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730134685 NPI number — SUBURBAN MEDICAL EQUIPMENT & SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUBURBAN MEDICAL EQUIPMENT & SUPPLIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730134685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 HAMPTON PARK BLVD
Provider Second Line Business Mailing Address:
STE. H
Provider Business Mailing Address City Name:
CAPITOL HEIGHTS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20743-3827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-333-0563
Provider Business Mailing Address Fax Number:
301-333-0562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 HAMPTON PARK BLVD
Provider Second Line Business Practice Location Address:
STE. H
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-333-0563
Provider Business Practice Location Address Fax Number:
301-333-0562
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERSON
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
301-333-0563

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  R1000 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4398 . This is a "HEALTH RIGHT HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7617146 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 91045 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2621815 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 293039 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 17778 . This is a "HMO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: MJ76SU . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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