Organization
COMMUNITY DURABLE MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARD O'CONNOR (OWNER)
(215) 331-9812
Entity
Organization
Contact information
Practice address
4706 BLAKISTON ST, PHILADELPHIA, PA 19136-1515
(215) 331-9812
(215) 331-9816
Mailing address
3057 WINCHESTER AVE., PHILADELPHIA, PA 19136
(215) 331-9812
(215) 331-9816
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
6000004713
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002764000
BLUE CROSS
PA
05
—
0014580451
—
PA
05
—
0015804510003
—
PA
Enumeration date
02/28/2007
Last updated
04/04/2011
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