Provider Demographics
NPI:1194822478
Name:MEDICINE CHEST MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:MEDICINE CHEST MEDICAL SUPPLY, INC.
Other - Org Name:ECONOMY MEDICINE CHEST MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RES THERAPIST
Authorized Official - Phone:903-962-4251
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2762
Mailing Address - Country:US
Mailing Address - Phone:903-885-0821
Mailing Address - Fax:903-885-8734
Practice Address - Street 1:513 E GARLAND ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1984
Practice Address - Country:US
Practice Address - Phone:903-962-4251
Practice Address - Fax:903-885-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185109901OtherTPI
TX185109902OtherTPI
TX1194822478OtherNPI
TX185109902OtherTPI