Organization
KEYSTONE WHOLESALE CO
Active
Other names
Medicine Chest Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANNY GOLDBERG R.P. (PRESIDENT)
(402) 391-2659
Entity
Organization
Contact information
Practice address
7328 MAPLE STREET, OMAHA, NE 68134-6829
(402) 391-2659
(402) 391-0038
Mailing address
7328 MAPLE STREET, OMAHA, NE 68134-6829
(402) 391-2659
(402) 391-0038
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1125096
—
IA
05
—
93081454401
—
NE
01
—
9942
BCBS
IA
01
—
9942
BCBS
NE
Enumeration date
11/28/2006
Last updated
10/11/2007
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