Basic Information
| Provider Information | |||||||||
| NPI: | 1154326866 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY RESPIRATORY & MEDICAL SUPPLY, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5522 HARFORD RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212142231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102540202 | ||||||||
| FaxNumber: | 4102543912 | ||||||||
| Practice Location | |||||||||
| Address1: | 5522 HARFORD RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212142231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102540202 | ||||||||
| FaxNumber: | 4102543912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 12/16/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SUTER | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4102540202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | 019632 | MD | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 099978400 | 05 | MD | MEDICAID | 100002087 | 05 | DE | MEDICAID | 270857 | 01 | MD | ALLIANCE, MAMSI, ETAL | OTHER | 52175301 | 01 | MD | BCBS OF CUMBERLAND | OTHER | 52958 | 01 | MD | AMERGROUP | OTHER | 056215 | 01 | MD | NORTHWOOD NPN | OTHER | F381 | 01 | MD | CAREFIRST BC, ETAL | OTHER | 216994 | 01 | MD | HIGHMARK | OTHER | 37262 | 01 | MD | INJ. WORKERS INS. FUND | OTHER |