Provider Demographics
NPI:1396043097
Name:ALDRICH RESPIRATORY AND MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:ALDRICH RESPIRATORY AND MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:570-654-4551
Mailing Address - Street 1:5 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1891
Mailing Address - Country:US
Mailing Address - Phone:570-282-1402
Mailing Address - Fax:570-283-3377
Practice Address - Street 1:5 JOHN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1891
Practice Address - Country:US
Practice Address - Phone:570-282-1402
Practice Address - Fax:570-283-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000008650332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018709910001Medicaid
PA1457390221Medicare NSC