Healthcare Provider Details

I. General information

NPI: 1013143791
Provider Name (Legal Business Name): MEDICAL HOUSE SUPPLY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S WASHINGTON ST
FALLS CHURCH VA
22046-4414
US

IV. Provider business mailing address

440 S WASHINGTON ST
FALLS CHURCH VA
22046-4414
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-2290
  • Fax: 703-533-2291
Mailing address:
  • Phone: 703-533-2290
  • Fax: 703-533-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number075758900
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0206009376
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206009376
License Number StateVA

VIII. Authorized Official

Name: MS. KELLY BENKAHLA
Title or Position: C.E.O
Credential:
Phone: 703-533-2290