Provider Demographics
NPI:1700836541
Name:LONG TERM MEDICAL SUPPLY CORPORATION
Entity Type:Organization
Organization Name:LONG TERM MEDICAL SUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-456-5636
Mailing Address - Street 1:115 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1723
Mailing Address - Country:US
Mailing Address - Phone:641-456-2885
Mailing Address - Fax:641-456-4482
Practice Address - Street 1:116 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1724
Practice Address - Country:US
Practice Address - Phone:641-456-3192
Practice Address - Fax:641-456-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41739200Medicaid
IAF243213OtherMIDLANDS CHOICE
IA0100776Medicaid
IA25137OtherBLUE CROSS BLUE SHEID
WI41739200Medicaid
WI41739200Medicaid