Provider Demographics
NPI:1114921038
Name:DAVID A AWALT
Entity Type:Organization
Organization Name:DAVID A AWALT
Other - Org Name:SEYMOUR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-889-6060
Mailing Address - Street 1:110 W REIMAN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-2553
Mailing Address - Country:US
Mailing Address - Phone:940-889-6060
Mailing Address - Fax:940-889-6050
Practice Address - Street 1:110 W REIMAN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2553
Practice Address - Country:US
Practice Address - Phone:940-889-6060
Practice Address - Fax:940-889-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068341332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158522601Medicaid
TX158522602Medicaid
TX158522602Medicaid