1093800195 NPI number — AOC-DME CORP.

Table of content: (NPI 1093800195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093800195 NPI number — AOC-DME CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AOC-DME CORP.
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:
6
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:
1093800195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 577
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-532-5656
Provider Business Mailing Address Fax Number:
903-532-5665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8015 S US HWY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-532-5656
Provider Business Practice Location Address Fax Number:
903-532-5665
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
TROY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-532-5656

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0078401 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0078401 , 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: 531764 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200704961 . This is a "TAX ID #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 136130 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172871901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12007049617000 . This is a "DADS (TIN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 172871902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60R9386 . This is a "UCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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