1114388261 NPI number — UNITED STATES MEDICAL SUPPLY CO.

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 1114388261 NPI number — UNITED STATES MEDICAL SUPPLY CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED STATES MEDICAL SUPPLY CO.
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:
6
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:
1114388261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 S BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10960-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-358-3955
Provider Business Mailing Address Fax Number:
845-348-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 S. BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-358-3955
Provider Business Practice Location Address Fax Number:
845-348-0604
Provider Enumeration Date:
03/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
845-358-3955

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)

  • Identifier: 1013976828 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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