Provider Demographics
NPI:1518204759
Name:SPORTZ MED DME
Entity Type:Organization
Organization Name:SPORTZ MED DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-535-1698
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0595
Mailing Address - Country:US
Mailing Address - Phone:214-535-1698
Mailing Address - Fax:
Practice Address - Street 1:112 MAHONIA DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8516
Practice Address - Country:US
Practice Address - Phone:214-535-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies