# MEDSTAR MEDICAL SUPPLIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699702126
- **Authorized official:** MARCY D LONG (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (304) 842-6001

## Contact information

- **Practice address:** 166 THOMPSON DR, BRIDGEPORT, WV 26330-1644
- **Practice address phone:** (304) 842-6001
- **Practice address fax:** (304) 842-6111
- **Mailing address:** 166 THOMPSON DR, BRIDGEPORT, WV 26330-1644
- **Mailing address phone:** (304) 842-6001
- **Mailing address fax:** (304) 842-6111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BD1200X | Dialysis Equipment & Supplies (DME) | — | WV | Yes |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 07/21/2022