Provider Demographics
NPI:1225035801
Name:YELLABONE MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:YELLABONE MEDICAL EQUIPMENT INC.
Other - Org Name:YELLABONE MEDICAL EQUIPMENT INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-775-7100
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77806-0932
Mailing Address - Country:US
Mailing Address - Phone:979-775-7100
Mailing Address - Fax:979-775-7800
Practice Address - Street 1:2014 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1833
Practice Address - Country:US
Practice Address - Phone:979-775-7100
Practice Address - Fax:979-775-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068368332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5544690001Medicare NSC