Provider Demographics
NPI:1164740650
Name:FW MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:FW MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KUPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:817-456-4348
Mailing Address - Street 1:2 RAINTREE CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4823
Mailing Address - Country:US
Mailing Address - Phone:817-456-4348
Mailing Address - Fax:
Practice Address - Street 1:2 RAINTREE CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4823
Practice Address - Country:US
Practice Address - Phone:817-456-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier