Provider Demographics
NPI:1346221025
Name:EMPAC MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EMPAC MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:IBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-373-6200
Mailing Address - Street 1:9696 SKILLMAN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8264
Mailing Address - Country:US
Mailing Address - Phone:214-373-6200
Mailing Address - Fax:214-343-8000
Practice Address - Street 1:9696 SKILLMAN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8264
Practice Address - Country:US
Practice Address - Phone:214-373-6200
Practice Address - Fax:214-343-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0078280332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175967202Medicaid
TX0078280OtherWHOLESALE DEVICE DISTRIBU
TX175967201Medicaid
TX5416040001Medicare NSC