Healthcare Provider Details

I. General information

NPI: 1003832056
Provider Name (Legal Business Name): AMERICAN HOMECARE SUPPLY MIDATLANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 NORRISTOWN RD SUITE A
BLUE BELL PA
19422-2355
US

IV. Provider business mailing address

480 NORRISTOWN RD SUITE B & C
BLUE BELL PA
19422-2355
US

V. Phone/Fax

Practice location:
  • Phone: 610-260-3150
  • Fax: 610-828-4304
Mailing address:
  • Phone: 484-530-0880
  • Fax: 484-530-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP C SPROGER
Title or Position: VICE PRESIDENT
Credential:
Phone: 484-530-0880