Provider Demographics
NPI:1013241314
Name:ARIZONA MEDICAL EQUIPMENT & SUPPLY LLC
Entity Type:Organization
Organization Name:ARIZONA MEDICAL EQUIPMENT & SUPPLY LLC
Other - Org Name:AMES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-266-7255
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85311-0305
Mailing Address - Country:US
Mailing Address - Phone:623-266-7255
Mailing Address - Fax:623-266-7254
Practice Address - Street 1:4225 W GLENDALE AVE
Practice Address - Street 2:C106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8194
Practice Address - Country:US
Practice Address - Phone:623-266-7255
Practice Address - Fax:623-266-7254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA MEDICAL EQUIPMENT & SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1649284498OtherNPI
AZ1649284498OtherNPI