Provider Demographics
NPI:1942384516
Name:F.Y.I. MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:F.Y.I. MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGENETTA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-290-1505
Mailing Address - Street 1:490 WILDWOOD NORTH CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-0131
Mailing Address - Country:US
Mailing Address - Phone:205-290-1505
Mailing Address - Fax:205-290-1518
Practice Address - Street 1:490 WILDWOOD NORTH CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-0131
Practice Address - Country:US
Practice Address - Phone:205-290-1505
Practice Address - Fax:205-290-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06013840332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942531Medicaid
AL51501029OtherBC/BS DME PROVIDER #
AL0583300001Medicare NSC