Provider Demographics
NPI:1114939360
Name:CAPITAL MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:CAPITAL MEDICAL SUPPLY INC
Other - Org Name:CAP MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-353-0707
Mailing Address - Street 1:2233 TOMLYNN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3334
Mailing Address - Country:US
Mailing Address - Phone:804-353-0707
Mailing Address - Fax:
Practice Address - Street 1:2233 TOMLYNN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3334
Practice Address - Country:US
Practice Address - Phone:804-353-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009283332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010166381Medicaid
VA010166381Medicaid