Provider Demographics
NPI:1508882317
Name:BROSCO INTERNATIONAL INC
Entity Type:Organization
Organization Name:BROSCO INTERNATIONAL INC
Other - Org Name:SALTOM MEDICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANIYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-329-5555
Mailing Address - Street 1:925 N BRYAN BELT LINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2541
Mailing Address - Country:US
Mailing Address - Phone:972-329-5555
Mailing Address - Fax:972-692-8245
Practice Address - Street 1:925 N BRYAN BELT LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2541
Practice Address - Country:US
Practice Address - Phone:972-329-5555
Practice Address - Fax:972-329-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0038660332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7735450001OtherPTAN