Healthcare Provider Details

I. General information

NPI: 1316276520
Provider Name (Legal Business Name): MEDICAL FACILITIES OF AMERICA SUPPLY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 PENN FOREST BLVD SUITE 10
ROANOKE VA
24018-4374
US

IV. Provider business mailing address

2917 PENN FOREST BLVD SUITE 10
ROANOKE VA
24018-4374
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-7497
  • Fax: 540-339-9124
Mailing address:
  • Phone: 540-776-7497
  • Fax: 540-339-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NOVEL MARTIN
Title or Position: CFO MFA INC., MANAGER
Credential:
Phone: 540-776-7497