Provider Demographics
NPI:1114123890
Name:EXPRESS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EXPRESS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEBESSA
Authorized Official - Middle Name:ALEMAYEHU
Authorized Official - Last Name:DABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-346-8796
Mailing Address - Street 1:6521 ARLINGTON BLVD
Mailing Address - Street 2:SUITE#205
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3009
Mailing Address - Country:US
Mailing Address - Phone:703-533-7585
Mailing Address - Fax:866-866-3534
Practice Address - Street 1:6521 ARLINGTON BLVD
Practice Address - Street 2:SUITE#205
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3009
Practice Address - Country:US
Practice Address - Phone:703-533-7585
Practice Address - Fax:866-866-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114123890Medicaid
DC0392253 00Medicaid
MD018559100Medicaid
MD018559100Medicaid
DC0392253 00Medicaid