Healthcare Provider Details

I. General information

NPI: 1073589081
Provider Name (Legal Business Name): ACE MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 STONEY CREEK DR
FORT WAYNE IN
46825-4409
US

IV. Provider business mailing address

6155 STONEY CREEK DR
FORT WAYNE IN
46825-4409
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-3516
  • Fax: 260-471-2797
Mailing address:
  • Phone: 260-483-3516
  • Fax: 260-471-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. JANELLE D FORD
Title or Position: OWNER
Credential:
Phone: 260-483-3516