Provider Demographics
NPI:1841628609
Name:MEDASSURE INC
Entity type:Organization
Organization Name:MEDASSURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-470-9700
Mailing Address - Street 1:3739 KARICIO LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6819
Mailing Address - Country:US
Mailing Address - Phone:928-237-1590
Mailing Address - Fax:928-237-4636
Practice Address - Street 1:3739 KARICIO LN
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6819
Practice Address - Country:US
Practice Address - Phone:928-237-1590
Practice Address - Fax:928-237-4636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDASSURE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5519108332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies