1124393350 NPI number — MATRIX MEDICAL SUPPLIES COMPANY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124393350 NPI number — MATRIX MEDICAL SUPPLIES COMPANY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATRIX MEDICAL SUPPLIES COMPANY 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:
1124393350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
93 OLD YORK RD
Provider Second Line Business Mailing Address:
SUITE 1-446
Provider Business Mailing Address City Name:
JENKINTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-3925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-535-8800
Provider Business Mailing Address Fax Number:
215-933-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5425 OXFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-535-8800
Provider Business Practice Location Address Fax Number:
215-535-5604
Provider Enumeration Date:
03/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
SHERITA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-535-8800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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