Provider Demographics
NPI:1609029800
Name:ERNIES HOUSE
Entity Type:Organization
Organization Name:ERNIES HOUSE
Other - Org Name:ERNIES MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:PERCY
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DME
Authorized Official - Phone:817-386-3923
Mailing Address - Street 1:4321 MARTHA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2705
Mailing Address - Country:US
Mailing Address - Phone:817-386-3923
Mailing Address - Fax:817-386-3923
Practice Address - Street 1:4321 MARTHA LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2705
Practice Address - Country:US
Practice Address - Phone:817-386-3923
Practice Address - Fax:817-386-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies