1821166463 NPI number — ACCURATE MEDICAL EQUIPMENT AND SUPPLY CO., INC.

Table of content: (NPI 1821166463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821166463 NPI number — ACCURATE MEDICAL EQUIPMENT AND SUPPLY CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE MEDICAL EQUIPMENT AND 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:
1821166463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 S MAIN 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:
76104-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-878-5030
Provider Business Mailing Address Fax Number:
817-878-5127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 INDUSTRIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AZLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76020-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-444-0013
Provider Business Practice Location Address Fax Number:
817-444-0035
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015401-0002 . This is a "PACIFICARE PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8540617 . This is a "AETNA NON HMO PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0616588 . This is a "AETNA HMO PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 530801 . This is a "BCBS OF TEXAS PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 645665 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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