=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033979000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY ALLIANCE MEDICAL EQUIPMENT AND SUPPLY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2024
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 FRANKFORD AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-686-2151
-----------------------------------------------------
Fax | 215-437-9149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 FRANKFORD AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-686-2151
-----------------------------------------------------
Fax | 215-437-9149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | AUDREY FLETCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-272-7791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------