Provider Demographics
NPI:1790912533
Name:AFFIRM MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:AFFIRM MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-473-4425
Mailing Address - Street 1:6385 HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3335
Mailing Address - Country:US
Mailing Address - Phone:225-473-4425
Mailing Address - Fax:225-473-4429
Practice Address - Street 1:3389 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:DARROW
Practice Address - State:LA
Practice Address - Zip Code:70725
Practice Address - Country:US
Practice Address - Phone:225-473-4425
Practice Address - Fax:225-473-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6257820001Medicare NSC