Provider Demographics
NPI:1316276520
Name:MEDICAL FACILITIES OF AMERICA SUPPLY SERVICES, LLC
Entity type:Organization
Organization Name:MEDICAL FACILITIES OF AMERICA SUPPLY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO MFA INC., MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-7497
Mailing Address - Street 1:2917 PENN FOREST BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4374
Mailing Address - Country:US
Mailing Address - Phone:540-776-7497
Mailing Address - Fax:540-339-9124
Practice Address - Street 1:2917 PENN FOREST BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4374
Practice Address - Country:US
Practice Address - Phone:540-776-7497
Practice Address - Fax:540-339-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment