Provider Demographics
NPI:1033760343
Name:ATLANTIS MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ATLANTIS MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-407-2323
Mailing Address - Street 1:45 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1228
Mailing Address - Country:US
Mailing Address - Phone:617-842-8340
Mailing Address - Fax:617-405-4692
Practice Address - Street 1:692 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2814
Practice Address - Country:US
Practice Address - Phone:617-802-1999
Practice Address - Fax:617-405-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies