Provider Demographics
NPI:1023038569
Name:AKATA MEDICAL LLC
Entity Type:Organization
Organization Name:AKATA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:757-237-5701
Mailing Address - Street 1:118 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8093
Mailing Address - Country:US
Mailing Address - Phone:757-237-5701
Mailing Address - Fax:
Practice Address - Street 1:118 MALLARD DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8093
Practice Address - Country:US
Practice Address - Phone:757-237-5701
Practice Address - Fax:757-277-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS1753013332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5763040001Medicare NSC