=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902287816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERIMED PHARMACY & EQUIPMENT, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2015
-----------------------------------------------------
Last Update Date | 10/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 4TH ST W
-----------------------------------------------------
City | TIFTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31794-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-472-1067
-----------------------------------------------------
Fax | 229-472-1069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 4TH ST W
-----------------------------------------------------
City | TIFTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31794-4356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-472-1067
-----------------------------------------------------
Fax | 229-472-1069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL DELOACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-253-0067
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------