Provider Demographics
NPI:1083907554
Name:DRS MEDICAL SUPPLY & TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:DRS MEDICAL SUPPLY & TRANSPORTATION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AFEWORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-945-2185
Mailing Address - Street 1:50 S PICKETT ST STE 124
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7206
Mailing Address - Country:US
Mailing Address - Phone:571-319-0424
Mailing Address - Fax:866-909-8664
Practice Address - Street 1:50 S PICKETT ST STE 124
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7206
Practice Address - Country:US
Practice Address - Phone:571-319-0424
Practice Address - Fax:866-909-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA126139332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9581901295Medicaid
MD420653300Medicaid
VA6709520001Medicare NSC