Provider Demographics
NPI:1437304987
Name:MEDICAL DISTRIBUTION GROUP, INC.
Entity Type:Organization
Organization Name:MEDICAL DISTRIBUTION GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-744-2967
Mailing Address - Street 1:17 N MAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3335
Mailing Address - Country:US
Mailing Address - Phone:727-744-2967
Mailing Address - Fax:727-499-7355
Practice Address - Street 1:17 N MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3335
Practice Address - Country:US
Practice Address - Phone:727-744-2967
Practice Address - Fax:727-499-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies