Provider Demographics
NPI:1558639344
Name:MAYTREE MEDICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:MAYTREE MEDICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:817-224-2929
Mailing Address - Street 1:PO BOX 2614
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2614
Mailing Address - Country:US
Mailing Address - Phone:817-224-2929
Mailing Address - Fax:817-977-1980
Practice Address - Street 1:203 LORINE ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3434
Practice Address - Country:US
Practice Address - Phone:817-224-2929
Practice Address - Fax:817-977-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies