1073589081 NPI number — ACE MEDICAL SUPPLY, INC

Table of content: (NPI 1073589081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073589081 NPI number — ACE MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE MEDICAL SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACE FORMS & SYSTEMS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073589081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6155 STONEY CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-4409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-483-3516
Provider Business Mailing Address Fax Number:
260-471-2797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6155 STONEY CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-483-3516
Provider Business Practice Location Address Fax Number:
260-471-2797
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
JANELLE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
260-483-3516

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 026687600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2626512 . This is a "KENTUCKY PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6201052000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219865074A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2337813 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90004821 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2441973000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 756968 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874370556 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200255500A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000212825 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200310680A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 626219000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82638200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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