Provider Demographics
NPI:1518918796
Name:EVASYL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EVASYL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UDOAMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIEKEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-615-1900
Mailing Address - Street 1:950 W BIRCHWOOD AVE
Mailing Address - Street 2:1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8447
Mailing Address - Country:US
Mailing Address - Phone:480-615-1900
Mailing Address - Fax:480-615-1926
Practice Address - Street 1:950 W BIRCHWOOD AVE
Practice Address - Street 2:1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8447
Practice Address - Country:US
Practice Address - Phone:480-615-1900
Practice Address - Fax:480-615-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20108721332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies