Provider Demographics
NPI:1891777348
Name:LAUREL MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:LAUREL MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LETIZIA
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:814-472-5591
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:405 S. WEST ST.
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-0004
Mailing Address - Country:US
Mailing Address - Phone:814-472-5591
Mailing Address - Fax:814-472-7555
Practice Address - Street 1:405 S WEST ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1800
Practice Address - Country:US
Practice Address - Phone:814-472-5591
Practice Address - Fax:814-472-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010984030002Medicaid
PA281001OtherHIGHMARK BC BS NUMBER
PA281001OtherHIGHMARK BC BS NUMBER