Healthcare Provider Details

I. General information

NPI: 1407031099
Provider Name (Legal Business Name): AFFINITY DISTRIBUTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 S 14TH ST STE 46A
ABILENE TX
79605-5015
US

IV. Provider business mailing address

5109 82ND ST STE. 7-1140
LUBBOCK TX
79424-3028
US

V. Phone/Fax

Practice location:
  • Phone: 325-437-0335
  • Fax: 325-437-3764
Mailing address:
  • Phone: 325-437-0335
  • Fax: 325-437-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0098772
License Number StateTX

VIII. Authorized Official

Name: MR. AUBREY HINES
Title or Position: CEO
Credential:
Phone: 806-771-0335