Provider Demographics
NPI:1366658452
Name:SHENANDOAH MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:SHENANDOAH MEDICAL SUPPLY, INC.
Other - Org Name:SMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-337-0072
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:36 LUCAS RD
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0357
Mailing Address - Country:US
Mailing Address - Phone:540-337-0072
Mailing Address - Fax:540-337-0076
Practice Address - Street 1:36 LUCAS RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2335
Practice Address - Country:US
Practice Address - Phone:540-337-0072
Practice Address - Fax:540-337-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002426676332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies