MEDICARE: AFFORDABLE MEDICAL SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1407326416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	7200 ALBEMARLE RD STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-8110
Country	:	US
Telephone Number	:	980-613-8496
Fax Number	:	704-910-3995

Provider Business Practice Location Address
First Line	:	7200 ALBEMARLE RD STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-8110
Country	:	US
Telephone Number	:	704-890-2094
Fax Number	:	704-910-3995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELA PORTER
Credential	:
Telephone Number	:	704-890-2094

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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