Provider Demographics
NPI:1013936988
Name:AMERICAN EAGLE HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:AMERICAN EAGLE HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:LEIGHTON
Authorized Official - Last Name:ANSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-937-7377
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75168-0656
Mailing Address - Country:US
Mailing Address - Phone:972-937-7377
Mailing Address - Fax:972-937-6656
Practice Address - Street 1:201 AMANDA LANE
Practice Address - Street 2:104A
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75168-1390
Practice Address - Country:US
Practice Address - Phone:972-937-7377
Practice Address - Fax:972-937-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077830332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710626Medicaid
TX5257670001Medicare NSC