MEDICARE: PHYSICIAN MEDICAL SUPPLY INC

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		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669473427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	4229 MAJORNA DR
Second Line	:
City	:	WEST SALEM
State	:	OH
Zip	:	44287-9652
Country	:	US
Telephone Number	:	419-945-2980
Fax Number	:	419-945-2981

Provider Business Practice Location Address
First Line	:	4229 MAJORNA DR
Second Line	:
City	:	WEST SALEM
State	:	OH
Zip	:	44287-9652
Country	:	US
Telephone Number	:	419-945-2980
Fax Number	:	419-945-2981

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JACQUELINE BERRY ARMSTRONG
Credential	:	LSW
Telephone Number	:	419-945-2980

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/18/2013

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