1366635856 NPI number — AARON MEDICAL EQUIPMENT DISTRIBUTORS, LLC

Table of content: (NPI 1366635856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366635856 NPI number — AARON MEDICAL EQUIPMENT DISTRIBUTORS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AARON MEDICAL EQUIPMENT DISTRIBUTORS, LLC
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:
AMED
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:
1366635856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
582 NW UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34986-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-878-1096
Provider Business Mailing Address Fax Number:
772-878-1678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
582 NW UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34986-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-878-1096
Provider Business Practice Location Address Fax Number:
772-878-1678
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANNECHIARICO
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
V
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
772-878-1096

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  6680138681142 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 66-8013868114-2 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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