Provider Demographics
NPI:1710590534
Name:RESTORATIVE MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:RESTORATIVE MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-761-1290
Mailing Address - Street 1:1516 N 5TH ST UNIT 327
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3679
Mailing Address - Country:US
Mailing Address - Phone:267-313-3223
Mailing Address - Fax:
Practice Address - Street 1:1516 N 5TH ST UNIT 327
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3679
Practice Address - Country:US
Practice Address - Phone:267-761-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies