Provider Demographics
NPI:1225588346
Name:LARYNGECTOMY SUPPLIES OF TEXAS
Entity Type:Organization
Organization Name:LARYNGECTOMY SUPPLIES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-491-9469
Mailing Address - Street 1:274 HICKORY RUN
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4514
Mailing Address - Country:US
Mailing Address - Phone:830-491-9469
Mailing Address - Fax:855-631-0024
Practice Address - Street 1:274 HICKORY RUN
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-4514
Practice Address - Country:US
Practice Address - Phone:830-491-9469
Practice Address - Fax:855-631-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies