Provider Demographics
NPI:1265631063
Name:SUPPORT MEDICAL COMPANY
Entity Type:Organization
Organization Name:SUPPORT MEDICAL COMPANY
Other - Org Name:SUPPORT MEDICAL OF MULESHOE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-272-7552
Mailing Address - Street 1:202 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3854
Mailing Address - Country:US
Mailing Address - Phone:806-272-7552
Mailing Address - Fax:806-272-7561
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3854
Practice Address - Country:US
Practice Address - Phone:806-272-7552
Practice Address - Fax:806-272-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0089179332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0581190003Medicare ID - Type Unspecified