Provider Demographics
NPI:1235254947
Name:LOGOS MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:LOGOS MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-452-5701
Mailing Address - Street 1:5070 PARKSIDE AVE
Mailing Address - Street 2:SUITE 5100W
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4747
Mailing Address - Country:US
Mailing Address - Phone:215-452-5701
Mailing Address - Fax:215-452-0443
Practice Address - Street 1:5070 PARKSIDE AVE
Practice Address - Street 2:SUITE 5100W
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4747
Practice Address - Country:US
Practice Address - Phone:215-452-5701
Practice Address - Fax:215-452-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156245332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020765750001Medicaid
PA4985690001Medicare NSC