Provider Demographics
NPI:1649284498
Name:ARIZONA MEDICAL EQUIPMENT & SUPPLY LLC
Entity type:Organization
Organization Name:ARIZONA MEDICAL EQUIPMENT & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:3185 CLEARWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7119
Practice Address - Country:US
Practice Address - Phone:928-771-9228
Practice Address - Fax:928-771-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ888015906610332B00000X
AZ5517853332B00000X
AZC000771332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5727020001Medicare NSC