Healthcare Provider Details

I. General information

NPI: 1891777348
Provider Name (Legal Business Name): LAUREL MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S WEST ST
EBENSBURG PA
15931-1800
US

IV. Provider business mailing address

PO BOX 4 405 S. WEST ST.
EBENSBURG PA
15931-0004
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-5591
  • Fax: 814-472-7555
Mailing address:
  • Phone: 814-472-5591
  • Fax: 814-472-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN J LETIZIA
Title or Position: PRESIDENT
Credential: ATP
Phone: 814-472-5591