Provider Demographics
NPI:1619091782
Name:SUPREME MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:SUPREME MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-664-6818
Mailing Address - Street 1:4667 S LAKESHORE DR
Mailing Address - Street 2:BLDG. 4 SUITE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7293
Mailing Address - Country:US
Mailing Address - Phone:480-664-6818
Mailing Address - Fax:
Practice Address - Street 1:4667 S LAKESHORE DR
Practice Address - Street 2:BLDG. 4 SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7293
Practice Address - Country:US
Practice Address - Phone:480-664-6818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1547690332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5479190001Medicare NSC