Provider Demographics
NPI:1851424394
Name:SEPAMED, INC.
Entity Type:Organization
Organization Name:SEPAMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:CULMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-1667
Mailing Address - Street 1:538 E CABOT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3302
Mailing Address - Country:US
Mailing Address - Phone:610-563-7267
Mailing Address - Fax:
Practice Address - Street 1:9539 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3801
Practice Address - Country:US
Practice Address - Phone:215-677-1667
Practice Address - Fax:215-677-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA201898332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008701550001Medicaid
PA1008701550001Medicaid