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General NPI Number Information
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NPI Number | 1093053134
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Entity Type | Organization
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Legal Business Name | A&M MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 4176 W HOMESTEAD DR
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City | REXBURG
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State | ID
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Zip | 83440-3089
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Country | US
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Telephone | 208-359-0547
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Fax | 208-359-8014
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Provider Business Mailing Address
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Address Line | 4176 W HOMESTEAD DR
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City | REXBURG
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State | ID
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Zip | 83440-3089
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Country | US
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Telephone | 208-359-0547
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Fax | 208-359-8014
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Authorized Official
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Title or Position | MEMBER
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Name | ANJANETTE ROBERTS
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Credential |
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Telephone | 208-359-0547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 004139201
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License Number State | ID
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