Provider Demographics
NPI:1598934283
Name:FIELD OF DREAMS, INC
Entity Type:Organization
Organization Name:FIELD OF DREAMS, INC
Other - Org Name:SUPPORT HOSE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANCOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-331-1618
Mailing Address - Street 1:14531 INTERSTATE 27
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-331-1618
Mailing Address - Fax:806-331-3044
Practice Address - Street 1:14531 INTERSTATE 27
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-331-1618
Practice Address - Fax:806-331-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies