Provider Demographics
NPI:1619088762
Name:LEDDY MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:LEDDY MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-676-7329
Mailing Address - Street 1:PO BOX 3495
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-3495
Mailing Address - Country:US
Mailing Address - Phone:325-676-7329
Mailing Address - Fax:325-676-7378
Practice Address - Street 1:1049 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7931
Practice Address - Country:US
Practice Address - Phone:325-676-7329
Practice Address - Fax:325-676-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0949920001Medicare ID - Type Unspecified