Provider Demographics
NPI:1104002989
Name:ACCESS MEDICAL SUPPLY
Entity type:Organization
Organization Name:ACCESS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NNADOZIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:NWACHUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-710-5416
Mailing Address - Street 1:4801 QUEENSBURY CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1821
Mailing Address - Country:US
Mailing Address - Phone:540-842-6397
Mailing Address - Fax:540-710-5417
Practice Address - Street 1:10620 SPOTSYLVANIA AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2637
Practice Address - Country:US
Practice Address - Phone:540-710-5416
Practice Address - Fax:540-710-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104910332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5954460001Medicare NSC