Provider Demographics
NPI:1528182466
Name:KANDIE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:KANDIE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-740-7867
Mailing Address - Street 1:17300 DASHWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5712
Mailing Address - Country:US
Mailing Address - Phone:512-740-7867
Mailing Address - Fax:512-233-5957
Practice Address - Street 1:17300 DASHWOOD CREEK DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5712
Practice Address - Country:US
Practice Address - Phone:512-740-7867
Practice Address - Fax:512-233-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190780001Medicaid
TX190780002Medicaid
TX190780002Medicaid