Provider Demographics
NPI:1063830701
Name:3RD ST MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:3RD ST MEDICAL SUPPLY INC
Other - Org Name:DYNAMIC REPAIR SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABDELLATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-988-6585
Mailing Address - Street 1:5724 WESTBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1400
Mailing Address - Country:US
Mailing Address - Phone:714-988-6585
Mailing Address - Fax:
Practice Address - Street 1:5724 WESTBOURNE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1400
Practice Address - Country:US
Practice Address - Phone:714-988-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC REPAIR SOLUTIONS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-31
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6713910003Medicare NSC