Provider Demographics
NPI:1447339627
Name:COMMONWEALTH MEDICAL EQUIPMENT & SUPPLY LLC
Entity type:Organization
Organization Name:COMMONWEALTH MEDICAL EQUIPMENT & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-550-7701
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-4030
Mailing Address - Country:US
Mailing Address - Phone:804-550-7701
Mailing Address - Fax:804-550-7705
Practice Address - Street 1:10338 STONY RUN LN # B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-8129
Practice Address - Country:US
Practice Address - Phone:804-550-7701
Practice Address - Fax:804-550-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
237512OtherANTHEM
237512OtherANTHEM