Provider Demographics
NPI:1629375902
Name:PAULINE ANNETT MITCHELL-EJIMAKOR
Entity Type:Organization
Organization Name:PAULINE ANNETT MITCHELL-EJIMAKOR
Other - Org Name:EMPHASIS HEALTH AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:ANNETT
Authorized Official - Last Name:MITCHELL-EJIMAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-667-1594
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:SUITE 138E
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:240-667-1594
Mailing Address - Fax:240-667-1596
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 138E
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:240-667-1594
Practice Address - Fax:240-667-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16409541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6376150001Medicare NSC