Provider Demographics
NPI:1487679254
Name:NORTH CENTRAL MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL MEDICAL SUPPLIES, INC.
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:512-990-3074
Mailing Address - Street 1:2401 W PECAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3200
Mailing Address - Country:US
Mailing Address - Phone:512-990-3074
Mailing Address - Fax:512-251-4458
Practice Address - Street 1:2401 W PECAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3200
Practice Address - Country:US
Practice Address - Phone:512-990-3074
Practice Address - Fax:512-251-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065104332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1589269Medicaid
TX1589269Medicaid