Healthcare Provider Details

I. General information

NPI: 1730318296
Provider Name (Legal Business Name): FRANK A REZK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 FRANKLIN ST
JOHNSTOWN PA
15905-4303
US

IV. Provider business mailing address

PO BOX 337
EBENSBURG PA
15931-0337
US

V. Phone/Fax

Practice location:
  • Phone: 814-254-4218
  • Fax: 814-254-4431
Mailing address:
  • Phone: 814-471-0627
  • Fax: 814-471-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. FRANK A. REZK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 814-471-0627