Provider Demographics
NPI:1760817332
Name:AT MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:AT MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYERLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-570-8345
Mailing Address - Street 1:6651 GLADEL DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-5055
Mailing Address - Country:US
Mailing Address - Phone:618-570-8345
Mailing Address - Fax:618-473-2035
Practice Address - Street 1:6651 GLADEL DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-5055
Practice Address - Country:US
Practice Address - Phone:618-570-8345
Practice Address - Fax:618-473-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment