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General NPI Number Information
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NPI Number | 1881196285
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Entity Type | Organization
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Legal Business Name | MID VALLEY SUPPLY LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 170 BLUEBERRY HILL RD
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City | SHAVERTOWN
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State | PA
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Zip | 18708-9507
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Country | US
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Telephone | 570-696-9754
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Fax | 570-696-9756
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Provider Business Mailing Address
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Address Line | 170 BLUEBERRY HILL RD
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City | SHAVERTOWN
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State | PA
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Zip | 18708-9507
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Country | US
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Telephone | 570-696-9754
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Fax | 570-696-9756
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. CARLTON E HOUCK
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Credential |
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Telephone | 570-696-8754
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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 |
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License Number State |
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