Provider Demographics
NPI:1528336526
Name:AVIS MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:AVIS MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEVOSYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-280-1483
Mailing Address - Street 1:2223 S MONACO PKWY
Mailing Address - Street 2:UNIT A-1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5893
Mailing Address - Country:US
Mailing Address - Phone:720-280-1483
Mailing Address - Fax:303-736-2195
Practice Address - Street 1:2223 S MONACO PKWY
Practice Address - Street 2:UNIT A-1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5893
Practice Address - Country:US
Practice Address - Phone:720-280-1483
Practice Address - Fax:303-736-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies