Basic Information
| Provider Information | |||||||||
| NPI: | 1699879809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALL MED LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SABER MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 JERRY WEST HWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LOGAN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256013955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047522800 | ||||||||
| FaxNumber: | 3047522111 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 JERRY WEST HWY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LOGAN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256013955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047522800 | ||||||||
| FaxNumber: | 3047522111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | SABER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 3047210775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SABER MEDICAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 2231463 | 05 | OH | MEDICAID | 3810006761 | 05 | WV | MEDICAID | 90008459 | 05 | KY | MEDICAID |