1679881684 NPI number — AMAANI MEDICAL SUPPLIES,INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679881684 NPI number — AMAANI MEDICAL SUPPLIES,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMAANI MEDICAL SUPPLIES,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:
1679881684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26011 COOLIDGE HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-336-8990
Provider Business Mailing Address Fax Number:
248-336-8991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26011 COOLIDGE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-336-8990
Provider Business Practice Location Address Fax Number:
248-336-8991
Provider Enumeration Date:
09/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
JERYCEL
Authorized Official Middle Name:
DIPLOMA
Authorized Official Title or Position:
VICE-PRES./OWNER
Authorized Official Telephone Number:
248-336-8990

Provider Taxonomy Codes

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

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

  • Identifier: 1460948 . This is a "HEALTHCARE COMPUTER CORPORATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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