Provider Demographics
NPI:1891106985
Name:FAMILY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:FAMILY MEDICAL SUPPLY
Other - Org Name:FAMILY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-277-8905
Mailing Address - Street 1:14241 E 4TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9084
Mailing Address - Country:US
Mailing Address - Phone:720-216-1147
Mailing Address - Fax:720-216-1571
Practice Address - Street 1:14241 E 4TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9084
Practice Address - Country:US
Practice Address - Phone:720-216-1147
Practice Address - Fax:720-216-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies