Provider Demographics
NPI:1609822576
Name:AMERICAN MEDICAL SUPPLY OF LOVELAND INC.
Entity Type:Organization
Organization Name:AMERICAN MEDICAL SUPPLY OF LOVELAND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPED, CFOM
Authorized Official - Phone:513-342-1927
Mailing Address - Street 1:1305 STATE ROUTE 28
Mailing Address - Street 2:STE C
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6081
Mailing Address - Country:US
Mailing Address - Phone:513-342-1927
Mailing Address - Fax:513-575-0733
Practice Address - Street 1:1305 STATE ROUTE 28
Practice Address - Street 2:STE C
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6081
Practice Address - Country:US
Practice Address - Phone:513-342-1927
Practice Address - Fax:513-575-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5613000001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2626368Medicaid
OH332822OtherAMERIGROUP
OH000000490296OtherANTHEM
OH2626368Medicaid
OH2626368Medicaid