Provider Demographics
NPI:1164493003
Name:MD MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:MD MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-556-1490
Mailing Address - Street 1:7687 S 180TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1048
Mailing Address - Country:US
Mailing Address - Phone:425-556-1490
Mailing Address - Fax:425-867-5087
Practice Address - Street 1:7687 S 180TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1048
Practice Address - Country:US
Practice Address - Phone:425-556-1490
Practice Address - Fax:425-867-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9032533Medicaid
WA0526660001Medicare NSC