Mid Valley Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MID VALLEY SUPPLY LLC

Practice address

170 Blueberry Hill Rd
Shavertown, PA 18708-9507

Phone

(570) 696-9754

Fax

(570) 696-9756

NPI assigned

Mar 2, 2018

Last updated

Mar 2, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carlton E Houck

Title

President/Owner

Phone

(570) 696-8754

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1881196285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BLUEBERRY HILL RD",
            "city": "SHAVERTOWN",
            "state": "PA",
            "postal_code": "187089507",
            "telephone_number": "570-696-9754",
            "fax_number": "570-696-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BLUEBERRY HILL RD",
            "city": "SHAVERTOWN",
            "state": "PA",
            "postal_code": "187089507",
            "telephone_number": "570-696-9754",
            "fax_number": "570-696-9756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "HOUCK",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "570-696-8754",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Shavertown, PA
• Providers in Shavertown, PA by specialty
• Durable Medical Equipment & Medical Supplies in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.