Provider Demographics
NPI:1114912334
Name:5 STAR MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:5 STAR MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-396-2233
Mailing Address - Street 1:465 PIKE RD
Mailing Address - Street 2:UNIT 113
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1620
Mailing Address - Country:US
Mailing Address - Phone:215-396-2233
Mailing Address - Fax:215-396-8325
Practice Address - Street 1:465 PIKE RD
Practice Address - Street 2:UNIT 113
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1620
Practice Address - Country:US
Practice Address - Phone:215-396-2233
Practice Address - Fax:215-396-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5088970001Medicare NSC