Provider Demographics
NPI:1265666192
Name:IMMACULATE MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:IMMACULATE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:682-551-9886
Mailing Address - Street 1:179 S WATSON RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5416
Mailing Address - Country:US
Mailing Address - Phone:682-551-9886
Mailing Address - Fax:682-551-9886
Practice Address - Street 1:179 S WATSON RD
Practice Address - Street 2:SUITE 418
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5416
Practice Address - Country:US
Practice Address - Phone:682-551-9886
Practice Address - Fax:682-551-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies