MEDICARE: SOUTH EASTERN PENNSYLVANIA MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	3000007911	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609060771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH EASTERN PENNSYLVANIA MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	533 E CABOT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3301
Country	:	US
Telephone Number	:	121-634-4250
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 E CABOT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3301
Country	:	US
Telephone Number	:	121-634-4250
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	JEROME CULMER
Credential	:
Telephone Number	:	12156344250

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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