Provider Demographics
NPI:1235540451
Name:TEXMED SUPPLY LLC
Entity Type:Organization
Organization Name:TEXMED SUPPLY LLC
Other - Org Name:PRUETT MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:NOVAN
Authorized Official - Last Name:KUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-772-0040
Mailing Address - Street 1:6813 CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6742
Mailing Address - Country:US
Mailing Address - Phone:254-772-0040
Mailing Address - Fax:254-772-1110
Practice Address - Street 1:6813 CACTUS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6742
Practice Address - Country:US
Practice Address - Phone:254-772-0040
Practice Address - Fax:254-772-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition