Provider Demographics
NPI:1114973252
Name:FIRST STATE MEDICAL SUPPLY COMPANY
Entity Type:Organization
Organization Name:FIRST STATE MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OKEZIE
Authorized Official - Middle Name:JM
Authorized Official - Last Name:UBI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:956-428-3313
Mailing Address - Street 1:305 E JACKSON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6888
Mailing Address - Country:US
Mailing Address - Phone:956-428-3313
Mailing Address - Fax:958-428-3397
Practice Address - Street 1:305 E JACKSON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6888
Practice Address - Country:US
Practice Address - Phone:956-428-3313
Practice Address - Fax:956-428-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066891332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4809110001Medicare ID - Type Unspecified