Provider Demographics
NPI:1376584250
Name:MERCER COUNTY REHAB SUPPLY, INC
Entity Type:Organization
Organization Name:MERCER COUNTY REHAB SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-258-4212
Mailing Address - Street 1:202 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1638
Mailing Address - Country:US
Mailing Address - Phone:800-258-4212
Mailing Address - Fax:724-458-6286
Practice Address - Street 1:202 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1638
Practice Address - Country:US
Practice Address - Phone:800-258-4212
Practice Address - Fax:724-458-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018916490002Medicaid
PA000246060OtherBCBS OF PA
PA3897380001Medicare NSC