Provider Demographics
NPI:1447568969
Name:AAA DISCOUNT MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:AAA DISCOUNT MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-893-9670
Mailing Address - Street 1:5471 N DIXIE HWY
Mailing Address - Street 2:#8
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4905
Mailing Address - Country:US
Mailing Address - Phone:561-893-9670
Mailing Address - Fax:561-893-9669
Practice Address - Street 1:5471 N DIXIE HWY
Practice Address - Street 2:#8
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4905
Practice Address - Country:US
Practice Address - Phone:561-893-9670
Practice Address - Fax:561-893-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313049332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691-226500OtherMEDICAID WAIVER