NPIMap

Organization Active NPI

Maxicare Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Riverdale, GA
National Provider Identifier
1790959187
Registry record updated Aug 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
06-19916 Issued in GA
Legal business name
MAXICARE MEDICAL SUPPLY
Practice address
804 Commerce Blvd
Suite a-32
Riverdale, GA 30296-7198
Phone
(770) 907-0194
Fax
(770) 907-0195
NPI assigned
Apr 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Efiong Eyo Mbaba, REGISTERED NURSENPI 1477763654
Title
Owner
Phone
(770) 907-0194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 06-19916 GA Primary

Addresses

Primary practice location

804 Commerce Blvd
Suite a-32
Riverdale, GA 30296-7198

Mailing address

804 Commerce Blvd
Suite a-32
Riverdale, GA 30296-7198
Phone (770) 907-0194

Other identifiers 1

IdentifierTypeStateIssuer
379763323AMedicaidGA

National Provider Directory

National Provider Directory

Locations

804 Commerce Blvd
Ste A32
Riverdale, GA 30296
Phone (770) 907-0194

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219622400000",
    "number": "1790959187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 COMMERCE BLVD",
            "address_2": "SUITE A-32",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302967198",
            "telephone_number": "770-907-0194",
            "fax_number": "770-907-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 COMMERCE BLVD",
            "address_2": "SUITE A-32",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302967198",
            "telephone_number": "770-907-0194",
            "fax_number": "770-907-0195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXICARE MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-08-25",
        "status": "A",
        "authorized_official_last_name": "MBABA",
        "authorized_official_first_name": "EFIONG",
        "authorized_official_middle_name": "EYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-907-0194",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "06-19916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379763323A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.