Provider Demographics
NPI:1457843666
Name:ACCUMED MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ACCUMED MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-587-5936
Mailing Address - Street 1:6923 WEST LOOP 1604 NORTH
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254
Mailing Address - Country:US
Mailing Address - Phone:210-507-2065
Mailing Address - Fax:
Practice Address - Street 1:6923 W LOOP 1604 N
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:210-507-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies