Provider Demographics
NPI:1568427581
Name:A-MED MEDICAL INC.
Entity Type:Organization
Organization Name:A-MED MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-935-1234
Mailing Address - Street 1:8900 E F LOWRY EXPWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591
Mailing Address - Country:US
Mailing Address - Phone:409-935-4901
Mailing Address - Fax:409-935-1334
Practice Address - Street 1:8900 E F LOWRY EXPWY
Practice Address - Street 2:SUITE 101
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-935-4901
Practice Address - Fax:409-935-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12290332B00000X
TX31723332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1021039OtherACM
TX530492OtherBLUE CROSS BLUE SHIELD
TX087240001Medicaid
TX016010301Medicaid
TX1021039OtherACM