Provider Demographics
NPI:1144978156
Name:AVID MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:AVID MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-282-3166
Mailing Address - Street 1:64 N PECOS RD STE 600
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7354
Mailing Address - Country:US
Mailing Address - Phone:800-282-3166
Mailing Address - Fax:725-218-3446
Practice Address - Street 1:64 N PECOS RD STE 600
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7354
Practice Address - Country:US
Practice Address - Phone:800-282-3166
Practice Address - Fax:725-218-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies