Organization
A-MED HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY N THACKER JR. (CFO)
(800) 289-5476
Entity
Organization
Contact information
Practice address
5082 BOLSA AVE, SUITE 103, HUNTINGTON BEACH, CA 92649-1065
(800) 289-5476
(714) 890-3810
Mailing address
5082 BOLSA AVE, SUITE 103, HUNTINGTON BEACH, CA 92649-1065
(800) 289-5476
(714) 890-3810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
100491
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002052
—
ID
05
—
166993
—
AZ
05
—
1990213
—
LA
05
—
3090793
—
CT
05
—
4574117
—
MI
05
—
55785301
—
HI
05
—
5604755
—
MT
05
—
90052242
—
KY
05
—
9198574017
—
NC
05
—
931659
—
IA
05
—
953763705001
—
IL
05
—
958763
—
OH
05
—
98002595
—
CO
05
—
DME00250H
—
CA
05
—
MS476CA
—
AK
Enumeration date
06/16/2006
Last updated
08/22/2020
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