Provider Demographics
NPI:1215133376
Name:MEDICAL SUPPLY GROUP, LLC
Entity type:Organization
Organization Name:MEDICAL SUPPLY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-931-3019
Mailing Address - Street 1:190 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST VIEW
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1334
Mailing Address - Country:US
Mailing Address - Phone:412-931-3019
Mailing Address - Fax:412-931-5844
Practice Address - Street 1:190 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:WEST VIEW
Practice Address - State:PA
Practice Address - Zip Code:15229-1334
Practice Address - Country:US
Practice Address - Phone:412-931-3019
Practice Address - Fax:412-931-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4867220002Medicare NSC
4867220002Medicare PIN