1912986597 NPI number — ABSOLUTE MEDICAL EQUIPMENT, 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 1912986597 NPI number — ABSOLUTE MEDICAL EQUIPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE MEDICAL EQUIPMENT, 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:
1912986597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E GORDON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30263-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-854-9234
Provider Business Mailing Address Fax Number:
678-854-9238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 MARKSMEN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-5918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-716-3833
Provider Business Practice Location Address Fax Number:
770-716-3834
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEMPLES
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
CHAPPELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-854-9234

Provider Taxonomy Codes

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

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

  • Identifier: 00904736A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52864543-002 . This is a "BCBS SUPPLIER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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