Provider Demographics
NPI:1437325487
Name:PATRIARCH SUPPLY & SERVICES LLC
Entity Type:Organization
Organization Name:PATRIARCH SUPPLY & SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:OLUSEGUN
Authorized Official - Last Name:ANJORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-435-2105
Mailing Address - Street 1:5068 W PLANO PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4408
Mailing Address - Country:US
Mailing Address - Phone:972-447-8228
Mailing Address - Fax:972-447-8229
Practice Address - Street 1:5068 W PLANO PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4408
Practice Address - Country:US
Practice Address - Phone:972-447-8228
Practice Address - Fax:972-447-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0095687332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies