Provider Demographics
NPI:1073582003
Name:MEDICAL AID SUPPLY HOUSE INC
Entity Type:Organization
Organization Name:MEDICAL AID SUPPLY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-622-1211
Mailing Address - Street 1:3547 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1419
Mailing Address - Country:US
Mailing Address - Phone:770-622-1211
Mailing Address - Fax:770-622-1241
Practice Address - Street 1:3547 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1419
Practice Address - Country:US
Practice Address - Phone:770-622-1211
Practice Address - Fax:770-622-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA623509993A332B00000X
333300000X
GA623509993B335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333300000XSuppliersEmergency Response System Companies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA623509993BMedicaid
GA623509993AMedicaid
GA623509993BMedicaid
GA623509993AMedicaid