Provider Demographics
NPI:1881889202
Name:PURDENCIO MS SURPLUS INC.
Entity type:Organization
Organization Name:PURDENCIO MS SURPLUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:
Authorized Official - Last Name:GEAGEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-739-8092
Mailing Address - Street 1:5900 MAXHAM RD
Mailing Address - Street 2:SUITE#17
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-4258
Mailing Address - Country:US
Mailing Address - Phone:770-739-8092
Mailing Address - Fax:
Practice Address - Street 1:5900 MAXHAM RD
Practice Address - Street 2:SUITE#17
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4258
Practice Address - Country:US
Practice Address - Phone:770-739-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies