Provider Demographics
NPI: | 1922064666 |
---|---|
Name: | AMERICAN MEDICAL INC |
Entity Type: | Organization |
Organization Name: | AMERICAN MEDICAL INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | H |
Authorized Official - Middle Name: | JON |
Authorized Official - Last Name: | HALEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 918-341-4480 |
Mailing Address - Street 1: | 129 W BLUE STARR DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CLAREMORE |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74017 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-341-4480 |
Mailing Address - Fax: | 918-283-1814 |
Practice Address - Street 1: | 129 W BLUE STARR DR |
Practice Address - Street 2: | |
Practice Address - City: | CLAREMORE |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74017 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-341-4480 |
Practice Address - Fax: | 918-283-1814 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-04-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1061460001 | Medicare ID - Type Unspecified |