Provider Demographics
NPI:1407031099
Name:AFFINITY DISTRIBUTION, INC
Entity Type:Organization
Organization Name:AFFINITY DISTRIBUTION, INC
Other - Org Name:AFFINITY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-0335
Mailing Address - Street 1:5109 82ND ST
Mailing Address - Street 2:STE. 7-1140
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3028
Mailing Address - Country:US
Mailing Address - Phone:325-437-0335
Mailing Address - Fax:325-437-3764
Practice Address - Street 1:3301 S 14TH ST
Practice Address - Street 2:STE 46A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5015
Practice Address - Country:US
Practice Address - Phone:325-437-0335
Practice Address - Fax:325-437-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0098772332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5383350002Medicare NSC