Provider Demographics
NPI:1881691558
Name:PERSONAL SUPPORT MEDICAL SUPPLIERS INC
Entity type:Organization
Organization Name:PERSONAL SUPPORT MEDICAL SUPPLIERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HATOOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-7304
Mailing Address - Street 1:262 GEIGER ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1008
Mailing Address - Country:US
Mailing Address - Phone:215-464-7304
Mailing Address - Fax:215-437-6633
Practice Address - Street 1:262 GEIGER RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-464-7304
Practice Address - Fax:215-437-6633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL SUPPORT MEDICAL SUPPLIERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BP3500X, 332BX2000X, 335E00000X, 332B00000X
PAPP481409333600000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072869Medicaid
PA001850216-0005Medicaid
PA001850216-0007Medicaid
NJ0072869Medicaid