Healthcare Provider Details

I. General information

NPI: 1154484319
Provider Name (Legal Business Name): MID ATLANTIC MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WEST MAIN STREET
WAYNESBORO PA
17268
US

IV. Provider business mailing address

620 WEST MAIN STREET
WAYNESBORO PA
17268
US

V. Phone/Fax

Practice location:
  • Phone: 717-762-9555
  • Fax: 717-762-1967
Mailing address:
  • Phone: 717-762-9555
  • Fax: 717-762-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number800001034
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3000007277
License Number StatePA

VIII. Authorized Official

Name: MARSHALL H LANEHART
Title or Position: PRESIDENT
Credential: CRT
Phone: 717-762-9555