Provider Demographics
NPI:1164641775
Name:MEDICAL ELECTRONICS & SUPPLIES INC.
Entity Type:Organization
Organization Name:MEDICAL ELECTRONICS & SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-0819
Mailing Address - Street 1:750 SALEM DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7758
Mailing Address - Country:US
Mailing Address - Phone:270-683-0818
Mailing Address - Fax:270-688-0553
Practice Address - Street 1:750 SALEM DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7758
Practice Address - Country:US
Practice Address - Phone:270-683-0818
Practice Address - Fax:270-688-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007238332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10086334OtherCDPHP
KYA2183178OtherOXFORD
KY020683OtherSIHO
KY356131400OtherUS DEPARTMENT OF LABOR
KY=========OtherTAX ID
KY356131400OtherUS DEPARTMENT OF LABOR
KY356131400OtherUS DEPARTMENT OF LABOR