Provider Demographics
NPI:1477552214
Name:USA MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:USA MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASSELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-798-7950
Mailing Address - Street 1:3316 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3814
Mailing Address - Country:US
Mailing Address - Phone:706-798-7950
Mailing Address - Fax:706-798-7656
Practice Address - Street 1:3316 PERKINS RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3814
Practice Address - Country:US
Practice Address - Phone:706-798-7950
Practice Address - Fax:706-798-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703320Medicaid
TX82-00264OtherUHC TEXAS
GA00771669AMedicaid
GA52779151OtherBCBS OF GA
MN074Q2USOtherBCBS OF MINNESOTA
FLA0000OtherBCBS OF FLORIDA
SCDME780Medicaid
TN4582357Medicaid
GA00771669AMedicaid
TN4582357Medicaid