Provider Demographics
NPI:1891179586
Name:PAYLESS MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:PAYLESS MEDICAL SUPPLIES, LLC
Other - Org Name:ONE SOURCE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:506-871-9455
Mailing Address - Street 1:13910 LYNMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3123
Mailing Address - Country:US
Mailing Address - Phone:866-533-0772
Mailing Address - Fax:866-629-5786
Practice Address - Street 1:108 N FAYETTEVILLE ST STE J
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-3203
Practice Address - Country:US
Practice Address - Phone:866-533-0772
Practice Address - Fax:866-629-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7504290001OtherMEDICARE PTAN