1164641775 NPI number — MEDICAL ELECTRONICS & SUPPLIES INC.

Table of content: (NPI 1164641775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164641775 NPI number — MEDICAL ELECTRONICS & SUPPLIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ELECTRONICS & SUPPLIES 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:
Provider Other Organization Name Type Code:
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:
1164641775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 SALEM DR
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303-7758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-683-0818
Provider Business Mailing Address Fax Number:
270-688-0553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 SALEM DR
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-7758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-683-0818
Provider Business Practice Location Address Fax Number:
270-688-0553
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWENER
Authorized Official Telephone Number:
270-683-0819

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  007238 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10086334 . This is a "CDPHP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: A2183178 . This is a "OXFORD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020683 . This is a "SIHO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 356131400 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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