Provider Demographics
NPI:1215188032
Name:AM MEDICAL DISTRIBUTORS INC.
Entity Type:Organization
Organization Name:AM MEDICAL DISTRIBUTORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-673-7100
Mailing Address - Street 1:10418 S PRAIRIE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-1832
Mailing Address - Country:US
Mailing Address - Phone:310-673-7100
Mailing Address - Fax:310-673-7101
Practice Address - Street 1:10418 S PRAIRIE AVE STE A
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1832
Practice Address - Country:US
Practice Address - Phone:310-673-7100
Practice Address - Fax:310-673-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA035898332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6138540001Medicare NSC