Provider Demographics
NPI:1558502963
Name:ACE MEDICAL SERVICES INC
Entity type:Organization
Organization Name:ACE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGHEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-882-2640
Mailing Address - Street 1:248 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3703
Mailing Address - Country:US
Mailing Address - Phone:909-882-2640
Mailing Address - Fax:909-882-2648
Practice Address - Street 1:248 E HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3703
Practice Address - Country:US
Practice Address - Phone:909-882-2640
Practice Address - Fax:909-882-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6199400001Medicare NSC