Healthcare Provider Details

I. General information

NPI: 1063656098
Provider Name (Legal Business Name): EAGLE MEDICAL EQUIPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 STEUBENVILLE PIKE
MC KEES ROCKS PA
15136-1315
US

IV. Provider business mailing address

5944 STEUBENVILLE PIKE
MC KEES ROCKS PA
15136-1315
US

V. Phone/Fax

Practice location:
  • Phone: 724-218-1051
  • Fax: 724-218-1165
Mailing address:
  • Phone: 724-218-1051
  • Fax: 724-218-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3000008451
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1023308950001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: SHAISTA HASAN
Title or Position: PRESIDENT
Credential:
Phone: 724-218-1051