Provider Demographics
NPI:1497919419
Name:MED-DEPOT, INC.
Entity Type:Organization
Organization Name:MED-DEPOT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-572-0520
Mailing Address - Street 1:2351 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 2135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:214-572-0520
Mailing Address - Fax:214-572-0511
Practice Address - Street 1:2478 FORT WORTH ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-4914
Practice Address - Country:US
Practice Address - Phone:972-606-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies