Healthcare Provider Details

I. General information

NPI: 1275987935
Provider Name (Legal Business Name): AMANIS MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 LEEDS CREEK CIR
ODENTON MD
21113-3903
US

IV. Provider business mailing address

176 LEEDS CREEK CIR
ODENTON MD
21113-3903
US

V. Phone/Fax

Practice location:
  • Phone: 240-354-0269
  • Fax: 410-674-2232
Mailing address:
  • Phone: 240-354-0269
  • Fax: 410-674-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR3870
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberR3870
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberR3870
License Number StateMD

VIII. Authorized Official

Name: MR. OLUBUNMI GREEN
Title or Position: PRESIDENT
Credential:
Phone: 240-354-0269