Provider Demographics
NPI:1922177443
Name:MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-563-2156
Mailing Address - Street 1:131 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2955
Mailing Address - Country:US
Mailing Address - Phone:360-563-9500
Mailing Address - Fax:360-568-0937
Practice Address - Street 1:131 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2955
Practice Address - Country:US
Practice Address - Phone:360-563-9500
Practice Address - Fax:360-568-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA872882OtherD.D.D.
WA9037938Medicaid
WA611533800OtherUS DEPT. OF LABOR
WA9037920Medicaid
WA9050139Medicaid
WA0112953OtherL & I
WA0812840002Medicare ID - Type Unspecified
WA9037938Medicaid