Provider Demographics
NPI:1417292822
Name:ACADEMY MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:ACADEMY MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-9991
Mailing Address - Street 1:2400 N TENAYA WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0420
Mailing Address - Country:US
Mailing Address - Phone:702-382-9991
Mailing Address - Fax:702-382-9636
Practice Address - Street 1:230 W FALLBROOK AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6228
Practice Address - Country:US
Practice Address - Phone:559-261-9641
Practice Address - Fax:559-261-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1293500004Medicare NSC