Provider Demographics
NPI:1508894114
Name:ACCESS DIABETIC SUPPLY LLC
Entity Type:Organization
Organization Name:ACCESS DIABETIC SUPPLY LLC
Other - Org Name:AOM HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:STOCKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-975-2281
Mailing Address - Street 1:PO BOX 841657
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1657
Mailing Address - Country:US
Mailing Address - Phone:954-975-2281
Mailing Address - Fax:800-477-5801
Practice Address - Street 1:2101 NW 33RD ST
Practice Address - Street 2:STE 1000A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1068
Practice Address - Country:US
Practice Address - Phone:954-975-2281
Practice Address - Fax:800-477-5801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENS & MINOR HEALTHCARE SUPPLY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-30
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118281Medicaid
AZ621773Medicaid
KY90003617Medicaid
IA0545533Medicaid
IN200340550AMedicaid
CT003110228Medicaid
KY1162329Medicaid
AR146034741Medicaid
HI568628Medicaid
ID806119600Medicaid
AKMS803FLMedicaid
AL009953365Medicaid
CAXDME03002Medicaid
FL022513401Medicaid
DE0001137316Medicaid
KS100403870AMedicaid
GA344347881AMedicaid
CO96835249Medicaid
CAXDME03002Medicaid
IL=========001Medicaid