Provider Demographics
NPI:1235160763
Name:AMERICAN NATIONAL DME INC
Entity Type:Organization
Organization Name:AMERICAN NATIONAL DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-792-9108
Mailing Address - Street 1:7807 E GREENWAY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1719
Mailing Address - Country:US
Mailing Address - Phone:877-710-7080
Mailing Address - Fax:877-710-7070
Practice Address - Street 1:7807 E GREENWAY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1719
Practice Address - Country:US
Practice Address - Phone:877-710-7080
Practice Address - Fax:877-710-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ877574Medicaid
AZ=========OtherFEDERAL TAX ID NUMBER
AZ5209770001Medicare NSC