Provider Demographics
NPI:1871879882
Name:AMERICAN HEALTH SUPPLY INC
Entity type:Organization
Organization Name:AMERICAN HEALTH SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DODRIDGE
Authorized Official - Middle Name:EVERETTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-418-6412
Mailing Address - Street 1:1080 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4778
Mailing Address - Country:US
Mailing Address - Phone:855-760-8957
Mailing Address - Fax:888-476-3461
Practice Address - Street 1:1080 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4778
Practice Address - Country:US
Practice Address - Phone:855-760-8957
Practice Address - Fax:888-476-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6668250001Medicare NSC