MEDICARE: AMERICAN HOMECARE SUPPLY MID ATLANTIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)

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	:	1710084918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HOMECARE SUPPLY MID ATLANTIC LLC

Provider Business Mailing Address
First Line	:	2710 EMRICK BLVD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18020-8012
Country	:	US
Telephone Number	:	610-882-8880
Fax Number	:	610-867-7023

Provider Business Practice Location Address
First Line	:	180 LEADERS HEIGHTS RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4742
Country	:	US
Telephone Number	:	717-699-5511
Fax Number	:	717-741-4752

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. LOUIS P ROCCO
Credential	:
Telephone Number	:	800-631-3031

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/09/2009

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