Provider Demographics
NPI:1396003729
Name:BETHESDA MEDICAL EQUIPMENT& SUPPLIES
Entity Type:Organization
Organization Name:BETHESDA MEDICAL EQUIPMENT& SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLABOSIPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-476-7124
Mailing Address - Street 1:5728 TUXEDO RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1316
Mailing Address - Country:US
Mailing Address - Phone:240-476-7124
Mailing Address - Fax:301-772-1665
Practice Address - Street 1:5728 TUXEDO RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1316
Practice Address - Country:US
Practice Address - Phone:240-476-7124
Practice Address - Fax:301-772-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies