Provider Demographics
NPI:1376711176
Name:JOSEPH ACKA
Entity Type:Organization
Organization Name:JOSEPH ACKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKA
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:434-584-0060
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0177
Mailing Address - Country:US
Mailing Address - Phone:434-584-0060
Mailing Address - Fax:434-584-0064
Practice Address - Street 1:1363 W DANVILLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-3901
Practice Address - Country:US
Practice Address - Phone:434-584-0060
Practice Address - Fax:434-584-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301300001Medicare NSC