Provider Demographics
NPI:1194563544
Name:ATHLON MED SUPPLY LLC
Entity type:Organization
Organization Name:ATHLON MED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:TANVEER
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-551-3848
Mailing Address - Street 1:611 E GRAND AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6399
Mailing Address - Country:US
Mailing Address - Phone:331-551-3848
Mailing Address - Fax:
Practice Address - Street 1:611 E GRAND AVE STE 1C
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6399
Practice Address - Country:US
Practice Address - Phone:331-551-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies