1497758361 NPI number — ACCURATE MEDICAL EQUIPMENT & SUPPLY CO INC

Table of content: (NPI 1497758361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497758361 NPI number — ACCURATE MEDICAL EQUIPMENT & SUPPLY CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE MEDICAL EQUIPMENT & SUPPLY CO 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:
1497758361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 HEMPHILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-882-1111
Provider Business Mailing Address Fax Number:
817-882-1118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 HEMPHILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-882-1111
Provider Business Practice Location Address Fax Number:
817-882-1118
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
817-878-5030

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  13285 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0014052730002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1531677 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0220255 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6014617 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 509449 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 81602800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143915 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4581931 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".