1528165792 NPI number — MOSSO'S MEDICAL SUPPLY COMPANY, LLC

Table of content: (NPI 1528165792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528165792 NPI number — MOSSO'S MEDICAL SUPPLY COMPANY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSSO'S MEDICAL SUPPLY COMPANY, LLC
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:
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NPI Number Information

NPI Number:
1528165792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15734 COLLECTION CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60693-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-879-6137
Provider Business Mailing Address Fax Number:
847-913-9024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 SECO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-372-3000
Provider Business Practice Location Address Fax Number:
412-372-6400
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZSITEK
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT AND ASST. SECRETARY
Authorized Official Telephone Number:
800-879-6137

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007288080015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007288080019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".