Provider Demographics
NPI:1821411497
Name:HOTASAN MEDICAL SUPPLIERS LLC
Entity Type:Organization
Organization Name:HOTASAN MEDICAL SUPPLIERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING AND BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ATOH
Authorized Official - Last Name:ACHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-516-1633
Mailing Address - Street 1:6602 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2962
Mailing Address - Country:US
Mailing Address - Phone:316-516-1633
Mailing Address - Fax:
Practice Address - Street 1:6602 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2962
Practice Address - Country:US
Practice Address - Phone:316-243-1872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7669047332B00000X
332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies