Organization
VILLAGE MEDICAL SUPPLY,LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EVELYN LUGO (OWNER)
(973) 652-7557
Entity
Organization
Contact information
Practice address
18 SHERWOOD DR, BLOOMSBURG, PA 17815-3085
(570) 389-1161
(570) 389-1163
Mailing address
18 SHERWOOD DR, BLOOMSBURG, PA 17815-3085
(570) 389-1161
(570) 389-1163
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
332BC3200X
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018678
—
NJ
05
—
1012127610002
—
PA
01
—
2509434
HIGHMARK BLUE CROSS BLUE SHIELD
PA
01
—
39H56
CAPITAL BLUE CROSS
PA
01
—
529426
WELLCARE
PA
Enumeration date
12/15/2006
Last updated
08/09/2011
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