MEDICARE: AHC 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	:	1447499447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHC MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	5323 MURRAY BLVD
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-6973
Country	:	US
Telephone Number	:	801-713-3254
Fax Number	:	888-542-6662

Provider Business Practice Location Address
First Line	:	2867 E COPPER POINT DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1716
Country	:	US
Telephone Number	:	801-713-3254
Fax Number	:	888-542-6662

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MARK EMMETT
Credential	:
Telephone Number	:	253-670-5700

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	05/01/2013

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