Provider Demographics
NPI:1508020256
Name:TYPO MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:TYPO MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEDAPO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-642-7775
Mailing Address - Street 1:2306 OAK LN
Mailing Address - Street 2:201
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8235
Mailing Address - Country:US
Mailing Address - Phone:972-642-7775
Mailing Address - Fax:
Practice Address - Street 1:2306 OAK LN
Practice Address - Street 2:201
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8235
Practice Address - Country:US
Practice Address - Phone:972-642-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0104940332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6320410001Medicare NSC