Provider Demographics
NPI:1154484319
Name:MID ATLANTIC MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MID ATLANTIC MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LANEHART
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:717-762-9555
Mailing Address - Street 1:620 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268
Mailing Address - Country:US
Mailing Address - Phone:717-762-9555
Mailing Address - Fax:717-762-1967
Practice Address - Street 1:620 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268
Practice Address - Country:US
Practice Address - Phone:717-762-9555
Practice Address - Fax:717-762-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA800001034332B00000X
PA3000007277332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
39HA53OtherCAPITAL
0203738OtherHIGHMARK
PA0011031920001Medicaid
0357210001Medicare ID - Type Unspecified