Provider Demographics
NPI:1639941321
Name:MEDISPACE SOLUTIONS LLC
Entity Type:Organization
Organization Name:MEDISPACE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EBNDAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-690-4600
Mailing Address - Street 1:2427 PEROT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2527
Mailing Address - Country:US
Mailing Address - Phone:267-225-6236
Mailing Address - Fax:
Practice Address - Street 1:2427 PEROT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2527
Practice Address - Country:US
Practice Address - Phone:267-225-6236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty