1477552214 NPI number — USA MEDICAL SUPPLY, INC

Table of content: (NPI 1477552214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477552214 NPI number — USA MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USA 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:
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:
1477552214
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:
3316 PERKINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30906-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-798-7950
Provider Business Mailing Address Fax Number:
706-798-7656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 PERKINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30906-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-798-7950
Provider Business Practice Location Address Fax Number:
706-798-7656
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CASSELS
Authorized Official First Name:
WALLACE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
706-798-7950

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7703320 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82-00264 . This is a "UHC TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00771669A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52779151 . This is a "BCBS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 074Q2US . This is a "BCBS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A0000 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DME780 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582357 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com