Provider Demographics
NPI:1316139926
Name:PENN HOME MEDICAL SUPPLY CO., LLC
Entity type:Organization
Organization Name:PENN HOME MEDICAL SUPPLY CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-948-2058
Mailing Address - Street 1:1704 PHILADELPHIA AVE
Mailing Address - Street 2:PO BOX 1031
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-1180
Mailing Address - Country:US
Mailing Address - Phone:814-948-2058
Mailing Address - Fax:814-948-7139
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-321-2901
Practice Address - Fax:412-321-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007985332BC3200X, 332BN1400X, 332BP3500X, 332BX2000X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1535665OtherUMWA
PA0017226640002Medicaid
PA040020700OtherDOL
PA152805OtherUNISON HEALTH PLAN
PA297884OtherHIGHMARK BCBS
PA1535665OtherUMWA