Provider Demographics
NPI:1679192827
Name:ATLASMEDART LLC
Entity Type:Organization
Organization Name:ATLASMEDART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAMASAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-1996
Mailing Address - Street 1:310 E BROADWAY STE 120
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:502-708-1599
Practice Address - Street 1:310 E BROADWAY STE 120
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1745
Practice Address - Country:US
Practice Address - Phone:502-630-1995
Practice Address - Fax:502-708-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN69001687AOtherIN STATE LICENSE
KY7100684010Medicaid
KY263672OtherKY STATE LICENSE