Provider Demographics
NPI:1447423124
Name:TRICARE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:TRICARE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-894-0144
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-0476
Mailing Address - Country:US
Mailing Address - Phone:806-894-0144
Mailing Address - Fax:806-894-6777
Practice Address - Street 1:1500 N BRYAN AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-3143
Practice Address - Country:US
Practice Address - Phone:806-872-3837
Practice Address - Fax:806-872-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015824802Medicaid
TX015824803Medicaid
TX0408460002Medicare NSC