MEDICARE: ON-SITE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1619204237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-SITE SERVICES

Provider Business Mailing Address
First Line	:	254 W. CHESTER PIKE
Second Line	:	SUITE 221
City	:	RIDLEY PARK
State	:	PA
Zip	:	19078
Country	:	US
Telephone Number	:	610-529-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 ARAMINGO AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4103
Country	:	US
Telephone Number	:	800-509-0775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MACEO KHALIFAH
Credential	:
Telephone Number	:	610-529-9023

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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