1437543212 NPI number — ASAASA MEDICAL SUPPLY & HOME OXYGEN

Table of content: MR. ALFONZO WATKINS MSE, LPC (NPI 1861792202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437543212 NPI number — ASAASA MEDICAL SUPPLY & HOME OXYGEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASAASA MEDICAL SUPPLY & HOME OXYGEN
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:
1437543212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8430 UNIVERSITY EXEC PARK DR
Provider Second Line Business Mailing Address:
SUITE 670
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-526-0426
Provider Business Mailing Address Fax Number:
704-526-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8430 UNIVERSITY EXEC PARK DR
Provider Second Line Business Practice Location Address:
SUITE 670
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-526-0426
Provider Business Practice Location Address Fax Number:
704-526-0440
Provider Enumeration Date:
03/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
IWUCHUKWU
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
980-319-7397

Provider Taxonomy Codes

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

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





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