Provider Demographics
NPI:1972544104
Name:AFFINITY DISTRIBUTION, INC.
Entity type:Organization
Organization Name:AFFINITY DISTRIBUTION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-0335
Mailing Address - Street 1:5109 82ND ST
Mailing Address - Street 2:SUITE 7-1140
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3028
Mailing Address - Country:US
Mailing Address - Phone:806-771-0335
Mailing Address - Fax:806-209-0111
Practice Address - Street 1:6207 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1401
Practice Address - Country:US
Practice Address - Phone:806-771-0335
Practice Address - Fax:806-209-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0079200332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147017100OtherFIRSTCARE
TX532069OtherBLUE CROSS BLUE SHIELD
TX172495702Medicaid
TX5383350001Medicare NSC