Provider Demographics
NPI:1427347202
Name:CONVENANT MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:CONVENANT MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-607-8025
Mailing Address - Street 1:1570 WALTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-6104
Mailing Address - Country:US
Mailing Address - Phone:214-607-8025
Mailing Address - Fax:214-553-9271
Practice Address - Street 1:1570 WALTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-6104
Practice Address - Country:US
Practice Address - Phone:214-607-8025
Practice Address - Fax:214-553-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies