Provider Demographics
NPI:1497862262
Name:MATCH MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:MATCH MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OKEM
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:AKWIWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-416-0820
Mailing Address - Street 1:PO BOX 1767
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30091-1767
Mailing Address - Country:US
Mailing Address - Phone:770-416-0820
Mailing Address - Fax:770-416-8045
Practice Address - Street 1:7001 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 400J
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3673
Practice Address - Country:US
Practice Address - Phone:770-416-0820
Practice Address - Fax:770-416-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4914740001Medicare ID - Type Unspecified