MEDICARE: HUB'S HOME OXYGEN & MEDICAL SUPPLIES, LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	1000002763	PA
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	1000002763	PA
3	335E00000X	Prosthetic/Orthotic Supplier	1000002763	PA
4	332B00000X	Durable Medical Equipment & Medical Supplies	1000002763	PA
5	332BX2000X	Oxygen Equipment & Supplies (DME)	1000002763	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	733651	OTHER	PA	AETNA US HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1399080	OTHER	PA	HIGHMARK BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	226037	OTHER	PA	HEALTHAMERICA
7	28061	OTHER	PA	ABP ADMINISTRATORS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	31728	OTHER	PA	GEISINGER HEALTH PLAN
10	814533	OTHER	PA	FIRST PRIORITY HEALTH / D
11	817624	OTHER	PA	FIRST PRIORITY HEALTH / O

NPI Number	:	1841240058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUB'S HOME OXYGEN & MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:	301-741-7792
Fax Number	:	301-741-7792

Provider Business Practice Location Address
First Line	:	740 HIGH ST STE 1002
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-3102
Country	:	US
Telephone Number	:	570-326-6521
Fax Number	:	570-323-8310

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/03/2026

740 HIGH ST STE 2001
WILLIAMSPORT, PA
17701-3102

Practice Phone: 570-321-2800
Practice Fax: 570-321-3351