Provider Demographics
NPI:1306025655
Name:LYNCH HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LYNCH HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-899-3636
Mailing Address - Street 1:4020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1966
Mailing Address - Country:US
Mailing Address - Phone:814-899-3636
Mailing Address - Fax:814-899-9933
Practice Address - Street 1:4020 MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1966
Practice Address - Country:US
Practice Address - Phone:814-899-3636
Practice Address - Fax:814-899-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004966332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016291780003Medicaid
PA1126020001Medicare NSC