Organization
MAIN LINE MEDICAL SUPPLIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN ROBERT BERNHARDT (CEO)
(610) 734-0800
Entity
Organization
Contact information
Practice address
303 S 69TH ST, UPPER DARBY, PA 19082-4213
(610) 734-0800
(610) 734-1326
Mailing address
303 S 69TH ST, UPPER DARBY, PA 19082-4213
(610) 734-0800
(610) 734-1326
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002645000
IBC KEYSTONEPC
PA
05
—
0009403370003
—
PA
01
—
00940337-02
AMERICHOICE
PA
01
—
1014794
KEYSTONE MERCY
PA
01
—
10419
ELDERHEATH
PA
01
—
133387
UNISON
PA
01
—
233328
BLUE CROSS BLUE SHIELD
PA
01
—
2720
AETNA
PA
Enumeration date
12/15/2006
Last updated
11/13/2008
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