Provider Demographics
NPI:1598807166
Name:UNIVERSAL MEDICAL SUPPLIERS, INC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL SUPPLIERS, INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-286-6804
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-0583
Mailing Address - Country:US
Mailing Address - Phone:570-286-6804
Mailing Address - Fax:570-286-7421
Practice Address - Street 1:326 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801
Practice Address - Country:US
Practice Address - Phone:570-286-6804
Practice Address - Fax:570-286-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 3336C0004X, 332B00000X, 332BN1400X, 332BX2000X
PAPP410434L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007728420008Medicaid
PA1007728420003Medicaid
3926714OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ4454502Medicaid
0444840001Medicare NSC