Provider Demographics
NPI:1265608517
Name:AFTERMARKET IND CORP
Entity type:Organization
Organization Name:AFTERMARKET IND CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTHEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-362-1422
Mailing Address - Street 1:4821 BRIAR ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-5039
Mailing Address - Country:US
Mailing Address - Phone:216-362-1422
Mailing Address - Fax:216-362-1426
Practice Address - Street 1:4821 BRIAR ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-5039
Practice Address - Country:US
Practice Address - Phone:216-362-1422
Practice Address - Fax:216-362-1426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFTERMARKET INDUSTRIES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0988865Medicaid