Provider Demographics
NPI:1780877209
Name:A & Y MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:A & Y MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-489-2043
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148-0555
Mailing Address - Country:US
Mailing Address - Phone:903-872-0210
Mailing Address - Fax:903-872-0310
Practice Address - Street 1:118 W MALL DR
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3164
Practice Address - Country:US
Practice Address - Phone:903-872-0210
Practice Address - Fax:903-872-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6059700001Medicare NSC