1356441786 NPI number — AERIE MEDICAL SUPPLY INC

Table of content: (NPI 1356441786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356441786 NPI number — AERIE MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AERIE 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:
AMS MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
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:
1356441786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 N GALLOWAY AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75149-2769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-216-7700
Provider Business Mailing Address Fax Number:
972-216-7714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 N GALLOWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75149-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-216-7700
Provider Business Practice Location Address Fax Number:
972-216-7714
Provider Enumeration Date:
09/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASKINS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
972-757-5065

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0076573 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1832206-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1832206-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".