Provider Demographics
NPI:1437914108
Name:A1 MEDICAL EQUIPMENT SERVICE AND REPAIR, LLC
Entity Type:Organization
Organization Name:A1 MEDICAL EQUIPMENT SERVICE AND REPAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OPERATOR/TECH
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CCRN, MEDIC
Authorized Official - Phone:573-300-5394
Mailing Address - Street 1:1638 COUNTY ROAD 467
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2976
Mailing Address - Country:US
Mailing Address - Phone:573-300-5394
Mailing Address - Fax:
Practice Address - Street 1:1638 COUNTY ROAD 467
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2976
Practice Address - Country:US
Practice Address - Phone:573-300-5394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment