Healthcare Provider Details

I. General information

NPI: 1972971893
Provider Name (Legal Business Name): FAMILY MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NC HIGHWAY 111 S STE B
GOLDSBORO NC
27534-6828
US

IV. Provider business mailing address

555 E NORTH LN STE 5075
CONSHOHOCKEN PA
19428-2490
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-3275
  • Fax: 919-736-3261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number02298
License Number StateNC

VIII. Authorized Official

Name: WENDY RUSSALESI
Title or Position: CCO
Credential:
Phone: 484-246-9499