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General NPI Number Information
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NPI Number | 1538311519
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Entity Type | Organization
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Legal Business Name | AFFORDABLE MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 2805 BRIDGEPORT WAY WEST STE. 23
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466
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Country | US
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Telephone | 253-267-5088
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Fax | 253-267-5157
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Provider Business Mailing Address
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Address Line | 2805 BRIDGEPORT WAY WEST STE. 23
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466
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Country | US
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Telephone | 253-267-5088
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Fax | 253-267-5157
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARLENE ALMA HOUSE
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Credential |
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Telephone | 253-267-5088
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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 | 602820498
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License Number State | WA
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