Provider Demographics
NPI:1275854002
Name:BETHESDA MEDICAL EQUIPMENT & SUPPLY CO, INC
Entity Type:Organization
Organization Name:BETHESDA MEDICAL EQUIPMENT & SUPPLY CO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMPHREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-872-0521
Mailing Address - Street 1:2775 CRUSE RD
Mailing Address - Street 2:STE 1603
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7140
Mailing Address - Country:US
Mailing Address - Phone:770-872-0521
Mailing Address - Fax:770-872-0521
Practice Address - Street 1:2775 CRUSE RD
Practice Address - Street 2:STE 1603
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7140
Practice Address - Country:US
Practice Address - Phone:770-872-0521
Practice Address - Fax:770-872-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment