Provider Demographics
NPI:1699048298
Name:A & M MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:A & M MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AIDNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-297-2770
Mailing Address - Street 1:4720 RUSH RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4720 RUSH RIVER TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2751
Practice Address - Country:US
Practice Address - Phone:817-297-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies