Provider Demographics
NPI:1396762282
Name:LENOX MEDICAL SUPPLY SERVICES, LLC
Entity type:Organization
Organization Name:LENOX MEDICAL SUPPLY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIJIOKE
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:IBETOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-387-1960
Mailing Address - Street 1:1712 14TH ST NW
Mailing Address - Street 2:SUITE 3-2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4309
Mailing Address - Country:US
Mailing Address - Phone:202-387-1960
Mailing Address - Fax:202-387-1963
Practice Address - Street 1:1712 14TH ST NW
Practice Address - Street 2:SUITE 3-2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4309
Practice Address - Country:US
Practice Address - Phone:202-387-1960
Practice Address - Fax:202-387-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037353400Medicaid
DC5584140001Medicare NSC