Provider Demographics
NPI:1972506350
Name:ACG MEDICAL SUPPLY INCORPORATED
Entity Type:Organization
Organization Name:ACG MEDICAL SUPPLY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GAMPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-463-0737
Mailing Address - Street 1:3502 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4005
Mailing Address - Country:US
Mailing Address - Phone:972-463-0737
Mailing Address - Fax:972-463-0920
Practice Address - Street 1:3502A LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4005
Practice Address - Country:US
Practice Address - Phone:972-463-0737
Practice Address - Fax:972-463-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0040125332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160948901Medicaid
TX160949701Medicaid
TX530962OtherBLUE CROSS BLUE SHIELD
TX530962OtherBLUE CROSS BLUE SHIELD