Provider Demographics
NPI:1255498200
Name:TX BLUBONNET DURABLE MEDICAL EQUIPMENT CO, INC.
Entity Type:Organization
Organization Name:TX BLUBONNET DURABLE MEDICAL EQUIPMENT CO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKZE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:940-458-9172
Mailing Address - Street 1:808 UTILITY RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-9131
Mailing Address - Country:US
Mailing Address - Phone:640-458-9172
Mailing Address - Fax:940-458-9175
Practice Address - Street 1:808 UTILITY RD
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9131
Practice Address - Country:US
Practice Address - Phone:940-458-9172
Practice Address - Fax:940-458-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies