Provider Demographics
NPI:1063557031
Name:AMD MEDICAL INC
Entity type:Organization
Organization Name:AMD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PISARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-558-0690
Mailing Address - Street 1:201 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-9606
Mailing Address - Country:US
Mailing Address - Phone:570-558-0690
Mailing Address - Fax:
Practice Address - Street 1:201 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-9606
Practice Address - Country:US
Practice Address - Phone:570-558-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019646470003Medicaid
PA0019646470003Medicaid