Provider Demographics
NPI:1336274166
Name:UNIVERSAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-914-3325
Mailing Address - Street 1:3039 PREMIERE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4905
Mailing Address - Country:US
Mailing Address - Phone:866-914-3325
Mailing Address - Fax:678-812-2725
Practice Address - Street 1:3039 PREMIERE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4905
Practice Address - Country:US
Practice Address - Phone:866-914-3325
Practice Address - Fax:678-812-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies