Healthcare Provider Details

I. General information

NPI: 1790071009
Provider Name (Legal Business Name): ACME MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 25TH AVE
GULFPORT MS
39501-2831
US

IV. Provider business mailing address

1804 25TH AVE
GULFPORT MS
39501-2831
US

V. Phone/Fax

Practice location:
  • Phone: 228-323-0416
  • Fax: 228-207-0520
Mailing address:
  • Phone: 228-323-0416
  • Fax: 228-207-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. FARID SAYAH
Title or Position: OWNER
Credential:
Phone: 228-323-0416