Provider Demographics
NPI:1225005523
Name:FHP MEDICAL SUPPLY
Entity type:Organization
Organization Name:FHP MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTANZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-495-7127
Mailing Address - Street 1:550 LOCUST ST
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:ST MICHAEL
Mailing Address - State:PA
Mailing Address - Zip Code:15951
Mailing Address - Country:US
Mailing Address - Phone:814-495-7127
Mailing Address - Fax:814-495-5327
Practice Address - Street 1:1300 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERHILL
Practice Address - State:PA
Practice Address - Zip Code:15958
Practice Address - Country:US
Practice Address - Phone:814-495-5920
Practice Address - Fax:814-495-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000001714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies