Provider Demographics
NPI:1144216896
Name:CADET MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:CADET MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MCKINLEY
Authorized Official - Last Name:YANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-726-3910
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-0712
Mailing Address - Country:US
Mailing Address - Phone:817-656-2690
Mailing Address - Fax:888-233-4861
Practice Address - Street 1:700 W HARWOOD RD
Practice Address - Street 2:SUITE E2
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3358
Practice Address - Country:US
Practice Address - Phone:817-656-2690
Practice Address - Fax:888-233-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077082332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4890070001Medicare NSC