Provider Demographics
NPI:1073718995
Name:ANGEL MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ANGEL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:UGHIOVHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-427-6372
Mailing Address - Street 1:PO BOX 60807
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20039-0807
Mailing Address - Country:US
Mailing Address - Phone:202-427-6372
Mailing Address - Fax:301-577-3771
Practice Address - Street 1:8919 HICKORY HILL AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2851
Practice Address - Country:US
Practice Address - Phone:301-577-2999
Practice Address - Fax:301-577-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2506332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies