Provider Demographics
NPI:1184611329
Name:AMERICAN SOUTHWEST CPM & MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:AMERICAN SOUTHWEST CPM & MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-957-4700
Mailing Address - Street 1:8686 N CENTRAL AVE
Mailing Address - Street 2:#112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3153
Mailing Address - Country:US
Mailing Address - Phone:602-957-4700
Mailing Address - Fax:602-264-9015
Practice Address - Street 1:8686 N CENTRAL AVE
Practice Address - Street 2:#112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3153
Practice Address - Country:US
Practice Address - Phone:602-957-4700
Practice Address - Fax:602-264-9015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SOUTHWEST CPM AND MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-03
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0684790001Medicare NSC