Provider Demographics
NPI:1790071009
Name:ACME MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ACME MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-323-0416
Mailing Address - Street 1:1804 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2831
Mailing Address - Country:US
Mailing Address - Phone:228-323-0416
Mailing Address - Fax:228-207-0520
Practice Address - Street 1:1804 25TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2831
Practice Address - Country:US
Practice Address - Phone:228-323-0416
Practice Address - Fax:228-207-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6672640001Medicare NSC