Provider Demographics
NPI:1861413205
Name:ANCILLARY SERVICES MANAGEMENT, LLC
Entity type:Organization
Organization Name:ANCILLARY SERVICES MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5722
Mailing Address - Street 1:333 NORTH SUMMIT STREET
Mailing Address - Street 2:ATTN: APRIL TERRY
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:419-252-6011
Mailing Address - Fax:800-375-5492
Practice Address - Street 1:333 NORTH SUMMIT STREET
Practice Address - Street 2:ATTN: APRIL TERRY
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2615
Practice Address - Country:US
Practice Address - Phone:419-252-6011
Practice Address - Fax:800-375-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0747347-01Medicaid
VA9136576Medicaid
IN100032140AMedicaid
MD168228800Medicaid
PA0012206080002Medicaid
OH0804973Medicaid
MI2749869Medicaid
WA9054925Medicaid
NJ3714403Medicaid
WA9054925Medicaid
MD168228800Medicaid