Provider Demographics
NPI:1073589081
Name:ACE MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:ACE MEDICAL SUPPLY, INC
Other - Org Name:ACE FORMS & SYSTEMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-483-3516
Mailing Address - Street 1:6155 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4409
Mailing Address - Country:US
Mailing Address - Phone:260-483-3516
Mailing Address - Fax:260-471-2797
Practice Address - Street 1:6155 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4409
Practice Address - Country:US
Practice Address - Phone:260-483-3516
Practice Address - Fax:260-471-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN026687600Medicaid
KY2626512OtherKENTUCKY PASSPORT
WV6201052000Medicaid
GA219865074AMedicaid
OH2337813Medicaid
KY90004821Medicaid
KY2441973000OtherPASSPORT ADVANTAGE
AZ756968Medicaid
MI874370556Medicaid
KS200255500AMedicaid
IN000000212825OtherBLUE CROSS BLUE SHIELD
IN200310680AMedicaid
MO626219000Medicaid
WI82638200Medicaid
AZ756968Medicaid
KY90004821Medicaid
IN200310680AMedicaid