Provider Demographics
NPI:1043271539
Name:SMA MEDICAL, INC.
Entity type:Organization
Organization Name:SMA MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHIVALYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-322-6590
Mailing Address - Street 1:940 PENNSYLVANIA BLVD
Mailing Address - Street 2:UNIT E
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7834
Mailing Address - Country:US
Mailing Address - Phone:215-322-6590
Mailing Address - Fax:215-322-9524
Practice Address - Street 1:940 PENNSYLVANIA BLVD
Practice Address - Street 2:UNIT E
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053-7834
Practice Address - Country:US
Practice Address - Phone:215-322-6590
Practice Address - Fax:215-322-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA027649291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018713050001Medicaid
PA01871305Medicaid
PA0018713050001Medicaid
050683Medicare PIN