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General NPI Number Information
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NPI Number | 1356638191
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Entity Type | Organization
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Legal Business Name | PROFIX MEDICAL REPAIR, LLC
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 1500 WALNUT ST SUITE 700
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3523
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Country | US
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Telephone | 267-687-7100
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Fax | 267-687-7101
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Provider Business Mailing Address
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Address Line | 1500 WALNUT ST SUITE 700
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3523
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Country | US
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Telephone | 267-687-7100
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Fax | 267-687-7101
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Authorized Official
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Title or Position | CEO
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Name | MISS DIANE HARVEY
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Credential |
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Telephone | 267-687-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 6000007884
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License Number State | PA
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