Provider Demographics
NPI:1265670483
Name:PA MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:PA MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:SERENGETTI CAPITAL, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNU
Authorized Official - Suffix:
Authorized Official - Credentials:MIS
Authorized Official - Phone:888-216-1544
Mailing Address - Street 1:131 CHURCH RD
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4141
Mailing Address - Country:US
Mailing Address - Phone:267-480-7171
Mailing Address - Fax:
Practice Address - Street 1:131 CHURCH RD
Practice Address - Street 2:SUITE 3G
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-4141
Practice Address - Country:US
Practice Address - Phone:267-480-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENGETTI CAPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA246034623/000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies