Provider Demographics
NPI:1093819401
Name:EASY ACCESS MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:EASY ACCESS MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-223-6044
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:MARSHALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18335-0023
Mailing Address - Country:US
Mailing Address - Phone:570-223-6044
Mailing Address - Fax:570-223-2745
Practice Address - Street 1:123 COLUMBIA DR
Practice Address - Street 2:JAY PARK SUITE A
Practice Address - City:MARSHALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:18335-0023
Practice Address - Country:US
Practice Address - Phone:570-223-6044
Practice Address - Fax:570-223-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005059332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT209841OtherBLUE CROSS BLUE SHEILD
MA0000Z68957OtherBLUE CROSS BLUE SHEILD
74817OtherANTHEM BLUE CROSS AND BLU
KS0000793852OtherBLUE CROSS BLUE SHEILD
306819OtherAVERA HEALTH PLANS INC
LA3624596OtherBLUE CROSS BLUE SHEILD
MA0000Z68957OtherBLUE CROSS BLUE SHEILD
MT209841OtherBLUE CROSS BLUE SHEILD
KS0000793852OtherBLUE CROSS BLUE SHEILD
=========OtherAETNA
MS=========OtherBLUE CROSS BLUE SHEILD
306819OtherAVERA HEALTH PLANS INC
=========OtherAMERICAN PIONEER
=========OtherAMERICAN REPUBLIC INSURAN
MO=========OtherBLUE CROSS BLE SHEILD
AL=========OtherBLUE CROSS BLUE SHEILD
NE=========001OtherBLUE CROSS BLUE SHEILD
=========100OtherAMERICAN PROGRESSIVE LIFE
=========100OtherBCBS FEDERAL EMPLOYEE PRO
=========100OtherAMERICAN PROGRESSIVE LIFE