Provider Demographics
NPI:1386839116
Name:LINCLON MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LINCLON MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:713-576-6903
Mailing Address - Street 1:PO BOX 10347
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78460-0347
Mailing Address - Country:US
Mailing Address - Phone:713-576-6903
Mailing Address - Fax:
Practice Address - Street 1:4009 BELLAIRE BLVD
Practice Address - Street 2:#K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1168
Practice Address - Country:US
Practice Address - Phone:713-576-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXDME332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies