Provider Demographics
NPI:1770875197
Name:PERFORMANCE BIOMEDICAL LLC
Entity type:Organization
Organization Name:PERFORMANCE BIOMEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-750-9622
Mailing Address - Street 1:10817 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2627
Mailing Address - Country:US
Mailing Address - Phone:267-750-9622
Mailing Address - Fax:888-688-0403
Practice Address - Street 1:10817 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2627
Practice Address - Country:US
Practice Address - Phone:267-750-9622
Practice Address - Fax:888-688-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027835960001Medicaid
PA1027835960001Medicaid