Provider Demographics
NPI:1982627915
Name:MCKEESPORT MED EQIP SVS
Entity type:Organization
Organization Name:MCKEESPORT MED EQIP SVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ARCHIBONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-687-0961
Mailing Address - Street 1:506 S MILLVALE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2118
Mailing Address - Country:US
Mailing Address - Phone:412-687-0961
Mailing Address - Fax:412-687-1126
Practice Address - Street 1:506 S MILLVALE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2118
Practice Address - Country:US
Practice Address - Phone:412-687-0961
Practice Address - Fax:412-687-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5453040001Medicare ID - Type Unspecified