Provider Demographics
NPI:1902934250
Name:FAMILY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-452-4444
Mailing Address - Street 1:124 ROBERT HALL CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2164
Mailing Address - Country:US
Mailing Address - Phone:757-452-4444
Mailing Address - Fax:757-452-4446
Practice Address - Street 1:124 ROBERT HALL CT
Practice Address - Street 2:SUITE 105
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2164
Practice Address - Country:US
Practice Address - Phone:757-452-4444
Practice Address - Fax:757-452-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010232953Medicaid
VA010232953Medicaid