1235254947 NPI number — LOGOS MEDICAL SUPPLY INC.

Table of content: (NPI 1235254947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235254947 NPI number — LOGOS MEDICAL SUPPLY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGOS MEDICAL SUPPLY 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:
1235254947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5070 PARKSIDE AVE
Provider Second Line Business Mailing Address:
SUITE 5100W
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19131-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-452-5701
Provider Business Mailing Address Fax Number:
215-452-0443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5070 PARKSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 5100W
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-452-5701
Provider Business Practice Location Address Fax Number:
215-452-0443
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILCHER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-452-5701

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  156245 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1020765750001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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