Provider Demographics
NPI:1366690539
Name:ACES MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ACES MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-377-2120
Mailing Address - Street 1:809 FLORIDA ST
Mailing Address - Street 2:SUITE D63
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 FLORIDA ST
Practice Address - Street 2:SUITE D63
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5505
Practice Address - Country:US
Practice Address - Phone:985-377-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D1087465291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory