Provider Demographics
NPI:1710915723
Name:LORRAINE SURGICAL SUPPLY OF WEST VIRGINIA INC
Entity Type:Organization
Organization Name:LORRAINE SURGICAL SUPPLY OF WEST VIRGINIA INC
Other - Org Name:FAMILY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEGAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN-STADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-345-1780
Mailing Address - Street 1:99 EDGINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-1904
Mailing Address - Fax:304-242-2587
Practice Address - Street 1:99 EDGINGTON LANE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-1904
Practice Address - Fax:304-242-1587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROFLOW INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV057397332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DME101OtherTHE HEALTH PLAN UOV
WV0147134000Medicaid
000221485OtherBCBS
WV0147134000Medicaid