Healthcare Provider Details

I. General information

NPI: 1326282575
Provider Name (Legal Business Name): AETNA MEDICAL SUPPLIES USA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W ABRAM ST STE B
ARLINGTON TX
76010-1059
US

IV. Provider business mailing address

401 W ABRAM ST STE B
ARLINGTON TX
76010-1059
US

V. Phone/Fax

Practice location:
  • Phone: 817-460-2311
  • Fax: 817-460-2344
Mailing address:
  • Phone: 817-460-2311
  • Fax: 817-460-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE NWAEFULU
Title or Position: OFFICER
Credential:
Phone: 817-460-2311