=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821030594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLAS MEDICAL EQUIPMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 PETERS CREEK RD NW B
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24017-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-427-7277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1717 PETERS CREEK RD NW B
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24017-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-427-7277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURA CARROLL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-427-7277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 103793
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------