Provider Demographics
NPI:1003845199
Name:PACO MEDICAL EQUIPMENT & SUPPLIES INC.
Entity Type:Organization
Organization Name:PACO MEDICAL EQUIPMENT & SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAJETAN
Authorized Official - Middle Name:OKEZIE
Authorized Official - Last Name:OKPOKPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-221-0560
Mailing Address - Street 1:9450 SKILLMAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8286
Mailing Address - Country:US
Mailing Address - Phone:214-221-0560
Mailing Address - Fax:214-221-6124
Practice Address - Street 1:9450 SKILLMAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8286
Practice Address - Country:US
Practice Address - Phone:214-221-0560
Practice Address - Fax:214-221-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770083Medicaid
5520780001Medicare ID - Type Unspecified
TX1770083Medicaid