1962432666 NPI number — DISTRICT HEALTHCARE & JANITORIAL SUPPLIES, INC.

Table of content: (NPI 1962432666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962432666 NPI number — DISTRICT HEALTHCARE & JANITORIAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISTRICT HEALTHCARE & JANITORIAL 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:
DHC MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
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:
1962432666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8799 DARCY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORESTVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20747-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-333-1750
Provider Business Mailing Address Fax Number:
301-333-8231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9430 LANHAM SEVERN RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-2651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-333-1750
Provider Business Practice Location Address Fax Number:
301-333-8231
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
PERNELL
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-333-1750

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  16226054 , 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: 025842500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40801 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 207060000 . This is a "TRICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 648588000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009106081 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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