Provider Demographics
NPI:1023500345
Name:STONY CREEK MEDICAL SALES
Entity type:Organization
Organization Name:STONY CREEK MEDICAL SALES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-421-4123
Mailing Address - Street 1:3110 TAFT RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4037
Mailing Address - Country:US
Mailing Address - Phone:267-421-4123
Mailing Address - Fax:
Practice Address - Street 1:3110 TAFT RD
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4037
Practice Address - Country:US
Practice Address - Phone:267-421-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment