Healthcare Provider Details

I. General information

NPI: 1730230749
Provider Name (Legal Business Name): PATRIOT MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 N LINCOLN AVE SUITE 100
BRIDGEPORT OH
43912-1645
US

IV. Provider business mailing address

253 N LINCOLN AVE SUITE 100
BRIDGEPORT OH
43912-1645
US

V. Phone/Fax

Practice location:
  • Phone: 740-635-1605
  • Fax: 740-635-1605
Mailing address:
  • Phone: 740-635-1605
  • Fax: 740-635-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMEL11103
License Number StateOH

VIII. Authorized Official

Name: MS. MICHALLE JENDRUSIK
Title or Position: PRESIDENT
Credential:
Phone: 740-635-1602