Provider Demographics
NPI:1528119542
Name:SPECTRUM MEDICAL, INC
Entity type:Organization
Organization Name:SPECTRUM MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-587-2992
Mailing Address - Street 1:8431 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4301
Mailing Address - Country:US
Mailing Address - Phone:301-587-2992
Mailing Address - Fax:301-587-0316
Practice Address - Street 1:8431 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4301
Practice Address - Country:US
Practice Address - Phone:301-587-2992
Practice Address - Fax:301-587-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1112332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD461868800Medicaid