Organization
CLUB MED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICE L FATE (DME SUPPLYER)
(888) 554-8850
Entity
Organization
Contact information
Practice address
7259 MANSFIELD AVE, PHILADELPHIA, PA 19138-1620
(888) 554-8850
(877) 829-6012
Mailing address
7259 MANSFIELD AVE, PHILADELPHIA, PA 19138-1620
(888) 554-8850
(877) 829-6012
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
02/23/2011
Last updated
02/23/2011
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