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General NPI Number Information
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NPI Number | 1013143791
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Entity Type | Organization
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Legal Business Name | MEDICAL HOUSE SUPPLY GROUP
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 440 S WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4414
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Country | US
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Telephone | 703-533-2290
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Fax | 703-533-2291
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Provider Business Mailing Address
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Address Line | 440 S WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4414
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Country | US
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Telephone | 703-533-2290
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Fax | 703-533-2291
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Authorized Official
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Title or Position | C.E.O
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Name | MS. KELLY BENKAHLA
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Credential |
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Telephone | 703-533-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 075758900
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0206009376
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0206009376
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License Number State | VA
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