=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508000290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | US HEALTHCARE SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2009
-----------------------------------------------------
Last Update Date | 11/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 BRIDGE ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08848-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-408-1480
-----------------------------------------------------
Fax | 800-516-1896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 BRIDGE ST P.O. BOX 372
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08848-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-408-1480
-----------------------------------------------------
Fax | 800-516-1896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JON PAUL LETKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-408-1480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------