Healthcare Provider Details

I. General information

NPI: 1396910964
Provider Name (Legal Business Name): ST. MICHAEL'S MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S 1ST ST SUITE A
LEHIGHTON PA
18235-2003
US

IV. Provider business mailing address

145 S 1ST ST SUITE A
LEHIGHTON PA
18235-2003
US

V. Phone/Fax

Practice location:
  • Phone: 610-377-3255
  • Fax: 610-377-3297
Mailing address:
  • Phone: 610-377-3255
  • Fax: 610-377-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA M GRAHAM
Title or Position: PARTNER
Credential:
Phone: 610-377-3255