Provider Demographics
NPI:1124250386
Name:ACTIVE AMERICAN MEDICAL SUPPLY CORP
Entity type:Organization
Organization Name:ACTIVE AMERICAN MEDICAL SUPPLY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-495-4400
Mailing Address - Street 1:13003 MURPHY RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3956
Mailing Address - Country:US
Mailing Address - Phone:281-495-4400
Mailing Address - Fax:281-495-4401
Practice Address - Street 1:13003 MURPHY RD
Practice Address - Street 2:SUITE G1
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3956
Practice Address - Country:US
Practice Address - Phone:281-495-4400
Practice Address - Fax:281-495-4401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE AMERICAN SCOOTER COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0107869332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment