Provider Demographics
NPI:1134452741
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:STE 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:806-771-3194
Practice Address - Street 1:11496 LUNA RD
Practice Address - Street 2:STE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-9425
Practice Address - Country:US
Practice Address - Phone:972-556-0335
Practice Address - Fax:972-556-0727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY DISTRIBUTION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-14
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX990887332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies