Provider Demographics
NPI:1750095162
Name:MAXIM MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:MAXIM MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFARAWATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-766-4948
Mailing Address - Street 1:18800 PRESTON RD STE 306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8573
Mailing Address - Country:US
Mailing Address - Phone:214-299-9599
Mailing Address - Fax:
Practice Address - Street 1:18800 PRESTON RD STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-8573
Practice Address - Country:US
Practice Address - Phone:214-299-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies