Provider Demographics
NPI:1821569294
Name:ATLANTIC COAST ORTHOPEDIC MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ATLANTIC COAST ORTHOPEDIC MEDICAL SUPPLIES
Other - Org Name:ACO MED SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:REBAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-749-6284
Mailing Address - Street 1:PO BOX 744966
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4966
Mailing Address - Country:US
Mailing Address - Phone:704-921-0116
Mailing Address - Fax:704-921-0117
Practice Address - Street 1:9006 PERIMETER WOODS DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2466
Practice Address - Country:US
Practice Address - Phone:704-921-0116
Practice Address - Fax:704-921-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment