Provider Demographics
NPI:1497719769
Name:MELINDA'S MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MELINDA'S MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-534-4013
Mailing Address - Street 1:910 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7205
Mailing Address - Country:US
Mailing Address - Phone:575-534-4013
Mailing Address - Fax:575-534-4016
Practice Address - Street 1:910 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7205
Practice Address - Country:US
Practice Address - Phone:575-534-4013
Practice Address - Fax:575-534-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02-376273-00 0332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS3742Medicaid
NM1023506OtherACM
NM1217660002Medicare ID - Type Unspecified