Provider Demographics
NPI:1104849561
Name:U S OSTOMY SUPPLY INC
Entity Type:Organization
Organization Name:U S OSTOMY SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:SIDDIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-354-9882
Mailing Address - Street 1:2350 AIRPORT FWY
Mailing Address - Street 2:SUITE #230
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6031
Mailing Address - Country:US
Mailing Address - Phone:817-354-9882
Mailing Address - Fax:817-354-8076
Practice Address - Street 1:2350 AIRPORT FWY
Practice Address - Street 2:SUITE #230
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6031
Practice Address - Country:US
Practice Address - Phone:817-354-9882
Practice Address - Fax:817-354-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088518332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0360700001Medicare UPIN