Provider Demographics
NPI:1538311519
Name:AFFORDABLE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:AFFORDABLE MEDICAL SUPPLY LLC
Other - Org Name:AFFORDABLE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:ALMA
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-267-5088
Mailing Address - Street 1:2805 BRIDGEPORT WAY WEST
Mailing Address - Street 2:STE. 23
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-267-5088
Mailing Address - Fax:253-267-5157
Practice Address - Street 1:2805 BRIDGEPORT WAY WEST
Practice Address - Street 2:STE. 23
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-267-5088
Practice Address - Fax:253-267-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602820498332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9062373Medicaid
WA6201020001Medicare NSC