Provider Demographics
NPI:1356638191
Name:PROFIX MEDICAL REPAIR, LLC
Entity type:Organization
Organization Name:PROFIX MEDICAL REPAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-687-7100
Mailing Address - Street 1:1500 WALNUT ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3523
Mailing Address - Country:US
Mailing Address - Phone:267-687-7100
Mailing Address - Fax:267-687-7101
Practice Address - Street 1:1500 WALNUT ST
Practice Address - Street 2:SUITE 700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3523
Practice Address - Country:US
Practice Address - Phone:267-687-7100
Practice Address - Fax:267-687-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000007884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies