Provider Demographics
NPI:1063476117
Name:DIS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DIS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:UMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-317-3664
Mailing Address - Street 1:8730 CHERRY LN
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6212
Mailing Address - Country:US
Mailing Address - Phone:301-317-3664
Mailing Address - Fax:301-317-5099
Practice Address - Street 1:8730 CHERRY LN
Practice Address - Street 2:SUITE A-2
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6212
Practice Address - Country:US
Practice Address - Phone:301-317-3664
Practice Address - Fax:301-317-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0008869Medicaid
GA430495185AMedicaid
MD4721440001Medicare NSC