Basic Information
| Provider Information | |||||||||
| NPI: | 1174580849 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEXION HEALTH MEDICAL SUPPLIES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MEDICAL SUPPLY CONNECTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6937 WARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105523426 | ||||||||
| FaxNumber: | 4105524837 | ||||||||
| Practice Location | |||||||||
| Address1: | 6937 WARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105523426 | ||||||||
| FaxNumber: | 4105524837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KIRLEY | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4105523426 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEXION HEALTH INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1465485 | 05 | LA | MEDICAID |