Provider Demographics
NPI:1568518033
Name:AAA MEDICAL FABRICATORS CORP
Entity Type:Organization
Organization Name:AAA MEDICAL FABRICATORS CORP
Other - Org Name:AAA MEDICAL FABRICATORS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PFLUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-944-7670
Mailing Address - Street 1:1006 SAGO PALM WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2004
Mailing Address - Country:US
Mailing Address - Phone:813-944-7670
Mailing Address - Fax:813-419-4937
Practice Address - Street 1:200 FRANDORSON CIR
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2689
Practice Address - Country:US
Practice Address - Phone:813-944-7670
Practice Address - Fax:813-419-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312631332B00000X, 332BC3200X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0322873-00Medicaid