Provider Demographics
NPI:1346355997
Name:ABC MEDICAL MART & SCRUBS
Entity Type:Organization
Organization Name:ABC MEDICAL MART & SCRUBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERRY-MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-424-9600
Mailing Address - Street 1:5622 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9626
Mailing Address - Country:US
Mailing Address - Phone:281-421-8740
Mailing Address - Fax:281-421-8741
Practice Address - Street 1:5622 GARTH ROAD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9626
Practice Address - Country:US
Practice Address - Phone:281-421-8740
Practice Address - Fax:281-421-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077860332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5209300001Medicare NSC