Provider Demographics
NPI:1558430942
Name:A&E MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:A&E MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIOSDADO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALMEDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-478-5513
Mailing Address - Street 1:11508 W 183RD ST
Mailing Address - Street 2:UNIT SE
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9487
Mailing Address - Country:US
Mailing Address - Phone:708-478-5513
Mailing Address - Fax:708-478-5514
Practice Address - Street 1:11508 W 183RD ST
Practice Address - Street 2:UNIT SE
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9487
Practice Address - Country:US
Practice Address - Phone:708-478-5513
Practice Address - Fax:708-478-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5583290001Medicare NSC