Provider Demographics
NPI:1992069942
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESUSA ALMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMOTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-677-7280
Mailing Address - Street 1:567 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2827
Mailing Address - Country:US
Mailing Address - Phone:972-677-7280
Mailing Address - Fax:
Practice Address - Street 1:567 STERLING DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2827
Practice Address - Country:US
Practice Address - Phone:972-677-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000732332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992069942Medicaid