Provider Demographics
NPI:1144459181
Name:LAUREL MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:LAUREL MEDICAL SUPPLIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LETIZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-338-1702
Mailing Address - Street 1:214 COLLEGE PARK PLZ
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2833
Mailing Address - Country:US
Mailing Address - Phone:800-338-1702
Mailing Address - Fax:814-472-7555
Practice Address - Street 1:214 COLLEGE PARK PLZ
Practice Address - Street 2:SUITE 111
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2833
Practice Address - Country:US
Practice Address - Phone:800-338-1702
Practice Address - Fax:814-472-7555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL MEDICAL SUPPLIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000007426335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001098403Medicaid
PA0162870004Medicare NSC