Provider Demographics
NPI:1013143791
Name:MEDICAL HOUSE SUPPLY GROUP
Entity Type:Organization
Organization Name:MEDICAL HOUSE SUPPLY GROUP
Other - Org Name:THE MEDICAL HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENKAHLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-533-2290
Mailing Address - Street 1:440 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4414
Mailing Address - Country:US
Mailing Address - Phone:703-533-2290
Mailing Address - Fax:703-533-2291
Practice Address - Street 1:440 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4414
Practice Address - Country:US
Practice Address - Phone:703-533-2290
Practice Address - Fax:703-533-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC075758900171WH0202X
VA0206009376332B00000X
0206009376332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
X946OtherNATIONAL BCBS FEDERAL
DC068395100Medicaid
VA1013143791Medicaid
DC075758900OtherDHCF WAIVER PROGRAM
1013143791OtherHEALTHNET FEDERAL SERVICES TRICARE NATIONAL
1013143791OtherHUMANA INC
382202OtherCIGNA (NATIONAL)
1102778656OtherGEHA
6477980001Medicare NSC
X946OtherNATIONAL BCBS FEDERAL