Provider Demographics
NPI:1265450605
Name:EAST SUBURBAN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:EAST SUBURBAN MEDICAL SUPPLY INC
Other - Org Name:ESMS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-657-2100
Mailing Address - Street 1:400 RODI RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4519
Mailing Address - Country:US
Mailing Address - Phone:412-371-0661
Mailing Address - Fax:412-242-4489
Practice Address - Street 1:400 RODI RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4519
Practice Address - Country:US
Practice Address - Phone:412-371-0661
Practice Address - Fax:412-242-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005681200001Medicaid
PA0269620001Medicare NSC