Provider Demographics
NPI:1619047636
Name:BACK TO BACK MEDICAL EQUIPMENT DIST LLC
Entity Type:Organization
Organization Name:BACK TO BACK MEDICAL EQUIPMENT DIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-477-0780
Mailing Address - Street 1:817 SOUTHMORE AVE
Mailing Address - Street 2:STE 100 I
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1115
Mailing Address - Country:US
Mailing Address - Phone:713-477-0780
Mailing Address - Fax:855-873-8930
Practice Address - Street 1:817 SOUTHMORE AVE
Practice Address - Street 2:STE 100 I
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1115
Practice Address - Country:US
Practice Address - Phone:713-477-0780
Practice Address - Fax:855-873-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0075614332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10048516OtherAMERIGROUP
TX1729295-01Medicaid
TX200436441OtherPHCS
TXHOMELINKOther200436441
TX100265265301OtherUNITEDHEALTH CARE
TX8200381OtherEVERCARE
TX200436441OtherINTEGRATED HEALTH PLAN
TX531679OtherBLUECROSS/BLUESHIELD OF T
TX1729295-02Medicaid
TX172929501OtherCOMM HEALTH CHOICE
TX172929501OtherCOMM HEALTH CHOICE
TX100265265301OtherUNITEDHEALTH CARE