Provider Demographics
NPI:1881656114
Name:ARIZONA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ARIZONA MEDICAL SUPPLY
Other - Org Name:WESTERN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOKSTOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-692-1354
Mailing Address - Street 1:831 E 340 S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3327
Mailing Address - Country:US
Mailing Address - Phone:888-870-3426
Mailing Address - Fax:888-798-4545
Practice Address - Street 1:831 E 340 S
Practice Address - Street 2:SUITE 130
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3327
Practice Address - Country:US
Practice Address - Phone:888-870-3426
Practice Address - Fax:888-798-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6684730001Medicare NSC