Provider Demographics
NPI:1568804623
Name:MIDCITIES MEDICAL SUPPLY DMEPOS
Entity Type:Organization
Organization Name:MIDCITIES MEDICAL SUPPLY DMEPOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMEPOS
Authorized Official - Phone:214-753-6721
Mailing Address - Street 1:215 N I 35 E
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5225
Mailing Address - Country:US
Mailing Address - Phone:972-223-2882
Mailing Address - Fax:972-223-2876
Practice Address - Street 1:215 N I 35 E
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5225
Practice Address - Country:US
Practice Address - Phone:972-223-2882
Practice Address - Fax:972-223-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies