Provider Demographics
NPI:1073628178
Name:THE HEALTHCARE STORE, INC
Entity Type:Organization
Organization Name:THE HEALTHCARE STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-589-1110
Mailing Address - Street 1:944 MELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4633
Mailing Address - Country:US
Mailing Address - Phone:817-589-1110
Mailing Address - Fax:817-595-1984
Practice Address - Street 1:944 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4633
Practice Address - Country:US
Practice Address - Phone:817-589-1110
Practice Address - Fax:817-595-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142575301Medicaid
TX531095OtherBCBS
TX1425753-02Medicaid
TX1425753-01Medicaid
TX0718950001Medicare ID - Type Unspecified