MAXICARE MEDICAL SUPPLY NPI 1790959187

NPI Information

  • NPI: 1790959187
  • Provider Name: MAXICARE MEDICAL SUPPLY
  • Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
  • Entity Type: Organization
  • Address: 804 COMMERCE BLVD
    SUITE A-32
    RIVERDALE, GA
    ZIP 30296
  • Phone: (770) 907-0194

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NPI Details

MAXICARE MEDICAL SUPPLY is a durable medical equipment medical supplies in Riverdale, GA. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. MAXICARE MEDICAL SUPPLY NPI is 1790959187. The provider is registered as an organization entity type.

The provider's business location address is:

804 COMMERCE BLVD
SUITE A-32
RIVERDALE, GA
ZIP 30296-198
Phone: (770) 907-0194
Fax: (770) 907-0195

The provider's authorized official is Efiong Eyo Mbaba .
The authorized official title is Owner and has the following contact phone number (770) 907-0194.

The enumeration date for this NPI number is 4/16/2008 and was last updated on 8/25/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical Supplies06-19916GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1379763323AMEDICAIDGEORGIA
25432230001MEDICARE NSCGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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