Provider Demographics
NPI:1982024832
Name:PHOENIX MEDICAL SALES
Entity Type:Organization
Organization Name:PHOENIX MEDICAL SALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-465-5248
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:BROOKLANDVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21022-0231
Mailing Address - Country:US
Mailing Address - Phone:855-825-8960
Mailing Address - Fax:866-242-4015
Practice Address - Street 1:110 WEST RD STE 214A
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2316
Practice Address - Country:US
Practice Address - Phone:855-825-8960
Practice Address - Fax:866-242-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies