Provider Demographics
NPI:1801459227
Name:AMS VANS LLC
Entity type:Organization
Organization Name:AMS VANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-387-6631
Mailing Address - Street 1:6275 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1830
Mailing Address - Country:US
Mailing Address - Phone:770-729-9400
Mailing Address - Fax:
Practice Address - Street 1:6275 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1830
Practice Address - Country:US
Practice Address - Phone:770-729-9400
Practice Address - Fax:678-935-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment