Provider Demographics
NPI:1093861080
Name:MCGLOTHLIN MEDICAL SUPPLY & UNIFORMS
Entity Type:Organization
Organization Name:MCGLOTHLIN MEDICAL SUPPLY & UNIFORMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAS
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-235-9001
Mailing Address - Street 1:1111 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-4717
Mailing Address - Country:US
Mailing Address - Phone:325-235-9001
Mailing Address - Fax:325-235-9005
Practice Address - Street 1:1111 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-4717
Practice Address - Country:US
Practice Address - Phone:325-235-9001
Practice Address - Fax:325-235-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662114332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6048240001Medicare NSC