Provider Demographics
NPI:1114996402
Name:APM PROVIDERS, INC
Entity Type:Organization
Organization Name:APM PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-241-5310
Mailing Address - Street 1:PO BOX 51582
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32240-1582
Mailing Address - Country:US
Mailing Address - Phone:904-241-5310
Mailing Address - Fax:904-247-9145
Practice Address - Street 1:1823 3RD ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-7469
Practice Address - Country:US
Practice Address - Phone:904-241-5310
Practice Address - Fax:904-247-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNOT REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440587Medicaid
FLR8467OtherBC/BS PROVIDER#
GA00719672AMedicaid
LA1684716Medicaid
NC7701843Medicaid
SCDM0962Medicaid
WV0226824000Medicaid
GA00719672AMedicaid
NC7701843Medicaid
GA00719672AMedicaid