Provider Demographics
NPI:1710261789
Name:LOUISVILLE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:LOUISVILLE MEDICAL SUPPLY INC
Other - Org Name:PHILADELPHIA MEDICAL SUPPLY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-803-3199
Mailing Address - Street 1:411 CENTER AVE N
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2920
Mailing Address - Country:US
Mailing Address - Phone:601-656-0802
Mailing Address - Fax:601-656-0804
Practice Address - Street 1:411 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2920
Practice Address - Country:US
Practice Address - Phone:601-656-0802
Practice Address - Fax:601-656-0804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISVILLE MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition