Provider Demographics
NPI:1215190392
Name:WALDREP MEDICAL
Entity Type:Organization
Organization Name:WALDREP MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-203-3030
Mailing Address - Street 1:330 OAKS TRL
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4083
Mailing Address - Country:US
Mailing Address - Phone:972-203-3030
Mailing Address - Fax:972-203-5566
Practice Address - Street 1:330 OAKS TRL
Practice Address - Street 2:SUITE 108
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4083
Practice Address - Country:US
Practice Address - Phone:972-203-3030
Practice Address - Fax:972-203-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies