Provider Demographics
NPI:1063678365
Name:PAT MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PAT MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLAWOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-464-2295
Mailing Address - Street 1:982 N GARDEN RIDGE BLVD
Mailing Address - Street 2:SUITE 220B
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:469-464-2295
Mailing Address - Fax:469-464-2296
Practice Address - Street 1:982 N GARDEN RIDGE BLVD
Practice Address - Street 2:SUITE 220B
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2827
Practice Address - Country:US
Practice Address - Phone:469-464-2295
Practice Address - Fax:469-464-2296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J-RAPHA HEALTHCARE SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies