Provider Demographics
NPI:1275990566
Name:MEDLINE DIRECT LLC
Entity Type:Organization
Organization Name:MEDLINE DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC, CSCS
Authorized Official - Phone:908-448-1562
Mailing Address - Street 1:5828 FRESH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9589
Mailing Address - Country:US
Mailing Address - Phone:619-928-6335
Mailing Address - Fax:
Practice Address - Street 1:5828 FRESH MEADOW DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9589
Practice Address - Country:US
Practice Address - Phone:908-448-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies