Healthcare Provider Details

I. General information

NPI: 1669473427
Provider Name (Legal Business Name): PHYSICIAN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 MAJORNA DR
WEST SALEM OH
44287-9652
US

IV. Provider business mailing address

4229 MAJORNA DR
WEST SALEM OH
44287-9652
US

V. Phone/Fax

Practice location:
  • Phone: 419-945-2980
  • Fax: 419-945-2981
Mailing address:
  • Phone: 419-945-2980
  • Fax: 419-945-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JACQUELINE BERRY ARMSTRONG
Title or Position: OWNER
Credential: LSW
Phone: 419-945-2980