Provider Demographics
NPI:1639333610
Name:PACON INVESTMENT INC D/B/A/ OMEGA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:PACON INVESTMENT INC D/B/A/ OMEGA MEDICAL SUPPLY
Other - Org Name:OMEGA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:OBIAGELI
Authorized Official - Last Name:NDUBUEZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-728-5198
Mailing Address - Street 1:13307 BIG CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5609
Mailing Address - Country:US
Mailing Address - Phone:301-809-1463
Mailing Address - Fax:301-809-1462
Practice Address - Street 1:13307 BIG CEDAR LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5609
Practice Address - Country:US
Practice Address - Phone:301-809-1463
Practice Address - Fax:301-809-1462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACON INVESTMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2609332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies