Provider Demographics
NPI:1477520161
Name:AMICABLE MEDICAL SUPPLIES AND EQUIPMENT, INC.
Entity Type:Organization
Organization Name:AMICABLE MEDICAL SUPPLIES AND EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:UKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-289-5200
Mailing Address - Street 1:1601 OSPREY DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8818
Mailing Address - Country:US
Mailing Address - Phone:972-289-5200
Mailing Address - Fax:469-533-1555
Practice Address - Street 1:1601 OSPREY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8818
Practice Address - Country:US
Practice Address - Phone:972-289-5200
Practice Address - Fax:469-533-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086573332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178729301Medicaid
TX178729302Medicaid
TX178729302Medicaid