Provider Demographics
NPI:1689731275
Name:HAWKEYE MEDICAL, LLC
Entity Type:Organization
Organization Name:HAWKEYE MEDICAL, LLC
Other - Org Name:COLMBIA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:F
Authorized Official - Last Name:KAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-832-4244
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3264
Mailing Address - Country:US
Mailing Address - Phone:443-832-4244
Mailing Address - Fax:443-832-4375
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3264
Practice Address - Country:US
Practice Address - Phone:443-832-4244
Practice Address - Fax:443-832-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012196700Medicaid
MD012196700Medicaid