1548544216 NPI number — LONG TERM MEDICAL SUPPLY CORP

Table of content: (NPI 1548544216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548544216 NPI number — LONG TERM MEDICAL SUPPLY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG TERM MEDICAL SUPPLY 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:
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:
1548544216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 N HOWARD ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
INDIANOLA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50125-2562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-962-2198
Provider Business Mailing Address Fax Number:
515-962-2085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 N HOWARD ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
INDIANOLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-456-2885
Provider Business Practice Location Address Fax Number:
515-962-2085
Provider Enumeration Date:
09/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLBEE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
HR
Authorized Official Telephone Number:
641-456-5636

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  191010836 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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