Provider Demographics
NPI:1063405991
Name:ACP MEDICAL SUPPLY
Entity type:Organization
Organization Name:ACP MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZLATKO
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:HODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-336-1814
Mailing Address - Street 1:4850 JOULE ST.
Mailing Address - Street 2:SUITE A - 1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4169
Mailing Address - Country:US
Mailing Address - Phone:800-652-1136
Mailing Address - Fax:888-873-7853
Practice Address - Street 1:4850 JOULE ST.
Practice Address - Street 2:SUITE A - 1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4169
Practice Address - Country:US
Practice Address - Phone:800-652-1136
Practice Address - Fax:888-873-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00525332B00000X
CAC15786335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXA000090Medicaid
NV4227640001Medicare NSC