Provider Demographics
NPI:1740345537
Name:SPECIALTY MEDICAL PRODUCTS, INC.
Entity type:Organization
Organization Name:SPECIALTY MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-1370
Mailing Address - Street 1:50 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2417
Mailing Address - Country:US
Mailing Address - Phone:610-644-1370
Mailing Address - Fax:610-644-3992
Practice Address - Street 1:3 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2417
Practice Address - Country:US
Practice Address - Phone:610-644-1370
Practice Address - Fax:610-644-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005931332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018842500001Medicaid
NJ0008338Medicaid
PA0018842500001Medicaid