Provider Demographics
NPI:1043396658
Name:FLAGSHIP MEDICAL, INC.
Entity Type:Organization
Organization Name:FLAGSHIP MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-992-7770
Mailing Address - Street 1:445 VEIT RD
Mailing Address - Street 2:SUITE# C
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1625
Mailing Address - Country:US
Mailing Address - Phone:215-992-7770
Mailing Address - Fax:215-992-7782
Practice Address - Street 1:445 VEIT RD
Practice Address - Street 2:SUITE# C
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1625
Practice Address - Country:US
Practice Address - Phone:215-992-7770
Practice Address - Fax:215-992-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025403000001Medicaid
NJ3562301Medicaid
PA4919610002Medicare NSC
PA4919610002Medicare ID - Type UnspecifiedPROVIDER# FLAGSHIP MEDICA