Provider Demographics
NPI:1114388261
Name:UNITED STATES MEDICAL SUPPLY CO.
Entity Type:Organization
Organization Name:UNITED STATES MEDICAL SUPPLY CO.
Other - Org Name:UNITED STATES MEDICAL SUPPLY CO
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-358-3955
Mailing Address - Street 1:286 S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4117
Mailing Address - Country:US
Mailing Address - Phone:845-358-3955
Mailing Address - Fax:845-348-0604
Practice Address - Street 1:286 S. BOULEVARD
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-358-3955
Practice Address - Fax:845-348-0604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED STATES MEDICAL SUPPLY CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1013976828Medicaid